- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …to work and adjust to different environments. Knowledge of Interqual and utilization review standards. Experience in clinical documentation within electronic ... required. Experience in Care Coordination, Discharge Planning, Clinical Documentation and Utilization Review preferred. Strong verbal, written and leadership… more
- Highmark Health (Pittsburgh, PA)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... dose and duration edits, quantity limits, step-care edits, generic sampling medical policy review and development, member facing outreach initiatives… more
- Guthrie (Sayre, PA)
- …not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical Social Work. Provides leadership for interdisciplinary ... performance improvement activities throughout the organization and for the medical staff. Responsibilities include Robert Packer Hospital, Robert Packer Hospital… more
- Fresenius Medical Center (Dallas, PA)
- …staff in problem solving. **PHYSICIANS:** + Facilitates the application process for physician privileges and compliance with FMS Medical Staff By-Laws. + ... implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records....Responsible for strong Director and physician relationships and facilitating staff relationships with physicians. +… more
- Guthrie (Sayre, PA)
- …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... serve as a practice support in the Patient Centered Medical Home development and process. The position is an...for all identified patients. + e. Collaborates with patient, physician , and other care team members in assessing the… 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...years' claims processing experience is required. + Knowledge of physician practice and hospital coding, and medical … more
- Veterans Affairs, Veterans Health Administration (Philadelphia, PA)
- …on current administrative guidelines. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… 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 ... with the LG Health Strategic Plan. Work collaboratively with health system and physician leadership to develop short and long-range strategic goals and tactics to… more
- UPMC (Pittsburgh, PA)
- …you have an interest in health insurance, but thrive on working in a medical office setting with face-to-face interaction with the members you are caring for? UPMC ... a full-time Clinical Care Manager to support our partnership with various physician practices. This role will support Shadyside Family Practice onsite in Shadyside… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more