- Penn Medicine (Philadelphia, PA)
- …(Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + Pennsylvania State Licensed ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...experience as a nurse case manager with knowledge of utilization review and third-party payors. We believe… more
- Commonwealth of Pennsylvania (PA)
- …diagnostic-related group assignment according to standard nomenclature and classification systems. Review medical records for completeness and accuracy and refer ... (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) . + Yes 05 WORK BEHAVIOR 1 - MEDICAL CODING AND RECORDS REVIEW Code diseases, operations,… more
- Wellpath (Collegeville, PA)
- …staff and ensure adherence to clinical protocols + Oversee chronic care clinics, utilization review , and quality improvement initiatives + Collaborate with the ... also play a key role in chronic care clinic oversight, pharmacy monitoring, and medical program review . **Key Responsibilities** + Provide direct medical … more
- Commonwealth of Pennsylvania (PA)
- …experience performing this Work Behavior as a charge nurse, head nurse, utilization review nurse, quality assurance nurse, or an industrial, employee ... documenting daily care in the designated forms and electronic medical records. Interested in learning more? Additional details regarding...this Work Behavior as a charge nurse, head nurse, utilization review nurse, quality assurance nurse, or… more
- UPMC (Pittsburgh, PA)
- …AMA FREIDA). + Coordinate and maintain documentation pertaining to the UPMC Medical Education Annual Program Oversight Review (APOR) and anticipated required ... UPMC Department of GIM Medical Education is hiring a full-time Medical...expense submissions for the trainees and department and track utilization of program specific funds. Submit documentation for supplemental… more
- LifePoint Health (Roaring Spring, PA)
- …required Life Talent education assignments within a timely manner. Keeps updated regarding Medical Center changes through meeting attendance and review of posted ... Conemaugh Nason Medical Center is seeking a part-time Registered Nurse...specialty clinics and patient-focused programs. *Essential Functions:* Demonstrated effective utilization of nursing process as basis for nursing practices.… more
- CVS Health (Pittsburgh, PA)
- …consistent responses to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical expertise ... CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work...that can be remote based, work from home. The Medical Director (Spine) will be a Subject Matter Expert… more
- Humana (Harrisburg, PA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health ... health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical … more
- Cognizant (Harrisburg, PA)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or...UB or HCFA paper or EDI information. + Evaluate medical records to determine if the service rendered was… more
- Humana (Harrisburg, PA)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health ... part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice… more