- Humana (Harrisburg, PA)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Sedgwick (Harrisburg, PA)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...required to include one (1) to three (3) years utilization review experience and three (3) years… more
- Humana (Harrisburg, PA)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- Highmark Health (Harrisburg, PA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more
- Humana (Harrisburg, PA)
- …group practice management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, ... put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work… more
- Geisinger (Bloomsburg, PA)
- Job Summary Geisinger offers outpatient Certified Medical Assistants a $3,000 bonus for eligible candidates. Geisinger has hundreds of community sites that allows ... Certified Medical Assistants to work to the top of their...for visit, weight, vital signs, visit screening information, medication review , and pertinent information for provider. + Sets up… more
- Geisinger (Mount Pocono, PA)
- …pertinent information, performing technical duties, documenting using the electronic medical record, and supporting a safe environment for patients. Provides ... billing inquiries. Graduate of an accredited 1-year certificate or 2-year diploma Medical Assistant program preferred. Certified Medical Assistant (CMA) or… more
- Veterans Affairs, Veterans Health Administration (Wilkes Barre, PA)
- …50% Clinical - Inpatient and/or Outpatient Oversight of Performance Improvement/Quality Assurance/ Utilization Review and evaluation to ensure that the four ... Summary The Assistant Chief of Medical Service (ACOS MS) provides administrative, clinical, and...improved: Access. Quality of Care, Customer Service/Patient Satisfaction, and Utilization Management / Efficiency of Care Serves as the… more
- Geisinger (Bellefonte, PA)
- …who qualify!! Graduate of an accredited 1-year certificate or 2-year diploma Medical Assistant program preferred. Certified Medical Assistant (CMA) or Registered ... Duties + Obtains and documents, using the rooming tool in the electronic medical record, the patient's reason for visit, weight, vital signs, visit screening… more
- Travelers Insurance Company (Harrisburg, PA)
- …influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State ... regulations and medical guidelines to establish medical ...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more