- WellSpan Health (Lebanon, PA)
- …and patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results in Anticoagulation ... of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education relative to health care… more
- Prime Therapeutics (Harrisburg, PA)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing referral… more
- Penn Medicine (Lancaster, PA)
- …leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across ... physiologic, psychological, and cognitive functions, through patient/provider office visits, nurse visits, and telephone triage. Collaborates with Physician and… more
- ChenMed (Philadelphia, PA)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... 1 slot), CGCAHPS (patient experience), clinical gaps closures, and medical cost measures. Each PCP will have goals for...or similar advanced degree in Nursing required + Current Nurse Practitioner Certification in the State of practice required… more
- St. Luke's University Health Network (Allentown, PA)
- …Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists billing staff ... outpatient denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. JOB… more
- Guthrie (Troy, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to...other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved… more
- LifePoint Health (Roaring Spring, PA)
- Conemaugh Nason Medical Center is seeking a part-time Registered Nurse for our Medical /Surgical Unit. The Staff Nurse has authority and accountability ... required Life Talent education assignments within a timely manner. Keeps updated regarding Medical Center changes through meeting attendance and review of posted… more
- Penn Medicine (Philadelphia, PA)
- …+ 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + Pennsylvania State Licensed Nurse ... the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and...a nurse case manager with knowledge of utilization review and third-party payors. We believe… 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
- ChenMed (Philadelphia, PA)
- …assess and record patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with inpatient staff for possible ... through external providers and healthcare systems. The Acute Care Nurse is an important member of the Complex Care...required + A minimum of one (1) year of utilization review and/or case management, home health,… more