- LifePoint Health (Johnstown, PA)
- …care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff, and Discharge Planners assure that payer requirements are ... rotating weekends on call * * *Your experience matters* Conemaugh Memorial Medical Center is part ofLifepoint Health, a diversified healthcare delivery network with… more
- Penn Medicine (Lancaster, PA)
- …Pennsylvania Board of Nursing. + Bachelor's degree in Nursing BSN . + Knowledge of utilization review or managed care. + Care management experience in a managed ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …and/or services based on the needs of the organization; + Participating in utilization review activities including but not limited to development of standards, ... Chief Medical Officer to include providing necessary research or review ; + Participating in the established on-call rotation including weekdays, weekends, nights… more
- CVS Health (Harrisburg, PA)
- …in Europe, APAC and Africa in support of an international network, medical cost management and overall claim/customer service strategies. This role will provide ... Risk Governance process for your assigned TPA(s). + Manage ongoing Aetna compliance review process for your assigned TPA(s). + Manage monthly billing / submission of… more
- Ryder System (Chambersburg, PA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** This ... and experience in core engineering and data analysis functions (slotting, utilization , labor planning, layouts, metrics, etc.) advanced required + Warehouse design… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …telepsychiatry services based on the needs of the organization; d. Participating in utilization review activities including but not limited to development of ... & Chief Medical Officer to include providing necessary research or review ; b. Participating in the established on call rotation including weekdays, weekends,… more
- St. Luke's University Health Network (Allentown, PA)
- …Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process. JOB ... after review of supporting documentation, CCI/LCD, carrier policy and utilization of coding software applications. The appeals process may include collaboration… more
- UPMC (Pittsburgh, PA)
- …patient information promptly. Collects and promptly processes demographic and medical necessity information. Participates constructively in the peer- review ... in adherence with established protocols and standards of care; accessing online medical command or other resources when appropriate, and employing the skills,… more
- CVS Health (Harrisburg, PA)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... compliance driven timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and… more
- Penn State Health (Hershey, PA)
- …information with dyad leaders. + Coach and mentor end users and requestors. + Review clinical trends as well as CQVA trends. + Maintain best practice for CQVA ... + Strategically expands the CQVA framework to support effective implementation, utilization , and continuous improvement. + Maintain and grow the CQVA process… more