- UPMC (Pittsburgh, PA)
- …The position will be fully remote! In this role, the DRG Specialist II will review clinical documentation within the medical record to ensure that all patient ... that were performed during an episode of care. + Review and evaluate focused UPMC DRG medical ...(CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine (MD) OR Doctor… more
- Amergis (Pittsburgh, PA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... optimum utilization of resources, service delivery, and compliance with medical regime. Essential Duties and Responsibilities: + Performs and coordinates the… 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
- 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
- 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
- YesCare Corp (Philadelphia, PA)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Other duties as ... in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as...and chart reviews as requested. Sponsors physician assistants or nurse practitioners as required. + Notifies Site Medical… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... Allegheny General Hospital assists patients and their support systems in managing medical conditions effectively. Our team of talented Case Managers aims to… more
- UPMC (Pittsburgh, PA)
- …+ Knowledge of computer technology, quality assurance activities, DRG, Quality Insights/ Utilization review background is highly preferred. + Ability to ... clinical documentation inquiry forms, regarding missing, unclear or conflicting medical record documentation to clarify the information, obtain needed documentation,… more
- St. Luke's University Health Network (Bethlehem, PA)
- …information. JOB DUTIES AND RESPONSIBILITIES: + Reviews documentation from Liaison/Intake nurse , referral source, Medical Director and admitting clinician. ... The Diagnosis and OASIS Specialist is responsible for coding pertinent medical information on patient classifications according to coding guidelines, OASIS Item… more