- CSL Behring (King Of Prussia, PA)
- …access with partners in marketing and patient services. + **Enhances Data Utilization ** : Aligns IT, Legal and business strategies to ensure patient data, ... & mental requirements.)_ 3 Days on Site, incl. Monday or Friday ** Travel Requirements** _(Domestic, International, frequency)_ + Up to approximately 10% - 15%… more
- Highmark Health (Camp Hill, PA)
- …+ Performs as the clinical subject matter expert for clinical, quality, care, utilization , high cost claim and population health management as the part of the ... and accounts after customer discussions.Participate in ad-hoc and annual clinical review meetings as needed to provide clinical, health and wellness perspective;… more
- FirstEnergy (Greensburg, PA)
- …"resistance-reactance" (R-X) diagrams, and step-distance diagrams, as well as the utilization of the short circuit, one-line, coordination graphics, relay checking ... Assisted Protection Engineering) software program. + Participating in the peer review , electronic issuance, as-left verification and retention of all protection… more
- Penn Medicine (Philadelphia, PA)
- …and/or departments may be required. + Additional administrative duties such as: medical records/mail room, surgery/procedure scheduling, etc. ** Travel :** + This ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- Prime Therapeutics (Harrisburg, PA)
- …well as the development of strategic business roadmaps that integrate both medical and pharmacy solutions. This position will provide leadership and direction ... + Lead the vision, strategy, and implementation of integrating medical and pharmacy solutions, fostering collaboration across departments and ensuring… more
- Sedgwick (Harrisburg, PA)
- …and physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL ... claim files are properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical claims which include state… more
- Cognizant (Harrisburg, PA)
- …experience. * Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. * Must be able to work with ... minimum of 2 years of claim processing is required. ** Travel :** None required **About the role:** As Claims Adjudication...HCFA paper or EDI information. * Responsible for reviewing medical records when necessary to determine if service rendered… more
- Highmark Health (Wexford, PA)
- … utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%) + ... + Responsible for all preauthorization entries into applicable databases (ie internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate… more
- ChenMed (Philadelphia, PA)
- …and 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...Suite + This position may require 50-75% of local travel EDUCATION AND EXPERIENCE CRITERIA: + ARNP or similar… more
- Geisinger (Danville, PA)
- …all Revenue Management teams and departments including Practice Consultants, Utilization Management and Care Management, Providers, Geisinger departments, clinical ... collections, payment plans, or other arrangements. + Performs accounts receivable review for special pricing packages and ensures appropriate allocation of funds.… more