- WellSpan Health (York, PA)
- …includes chart review , clinical physical assessment and interaction with the physician , nurses and therapists directly involved in the patient's care. + Includes ... admission. + Collaborates with the WellSpan Surgery and Rehabilitation Hospital medical director or assigned physician to confirm appropriateness of… 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
- CVS Health (Harrisburg, PA)
- …meal delivery, assists with securing DME, and helps to ensure timely physician follow-up. - Understands Payer/Plan benefits, policies, procedures, and can articulate ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current...timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more
- Aveanna Healthcare (Olyphant, PA)
- …appropriately skilled clinician, and within insurance authorization. - Responsible to manage utilization of direct care team members based on patient needs as well ... and distributes the patient/direct care team member schedule. Performs initial review of schedules for productivity/geographic issues. - Completes daily and weekly… more
- Prime Therapeutics (Harrisburg, PA)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to… more
- Penn Medicine (Lancaster, PA)
- …data pertinent to the patient's health or the situation, and concisely relays medical information to physician or APP. + Analyzes the assessment data ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- UPMC (Pittsburgh, PA)
- …business hours. In this role, you will be handling inpatient coding. You will review clinical documentation within the medical record to ensure that all patient ... during the episode of care and assign appropriate codes. Review appropriate documents in the patients' charts to accurately...on UPMC patients. + Identify incomplete documentation in the medical record and formulate a physician query… more
- Penn Medicine (Philadelphia, PA)
- …leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across ... optimal reimbursement for the hospital for services provided. Responsibilities: + Review chemo schedule in advance and determines patients insurance requirements for… more
- UPMC (Pittsburgh, PA)
- …the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals ... position may require occasional Weekend and Holiday Hours **Responsibilities:** + Reviews medical record daily to ensure patient continues to meet LOC requirements… more