- Humana (Harrisburg, PA)
- …teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to ... includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board… more
- Sunrise Senior Living (Haverford, PA)
- …assists with the Resident Assessment Instrument (RAI) process. + Reviews and assists in case management of both Medicare & non- Medicare guests/residents. + ... Ensures interdisciplinary notes reflect the care provided through daily random audits. + Ensures timely and accurate documentation in guests/residents charts. + Participates and provides leadership in the Clinical At-Risk meetings and the daily Prospective… more
- Sunrise Senior Living (Haverford, PA)
- …Certified Nursing Assistants (CNA); follows Resident Centered Care model. + Assists with case management of both Medicare and non- Medicare guests/residents ... as needed. + Participates in the Care Planning meetings. + Assists with providing clinical care and not limited to: urinary cauterization, tube feedings, applying/changing dressings, Accu-checks, medication management/administration, admission, transfer and… more
- Humana (Harrisburg, PA)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...NCD/LCD, MCG(R) or InterQual** **The Medical Director conducts clinical case reviews of requests received by members of the… more
- Heritage Ministries (Conneautville, PA)
- …responsible for the coordination and completion of necessary functions to assure Medicare and other payer's requirements are maintained in regards to clinical ... and documentation. The MDS Coordinator will act as a coordinator of MDS, Medicare , and Restorative Nursing functions. This individual will work in conjunction with… more
- Humana (Harrisburg, PA)
- …includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board ... experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute… more
- BAYADA Home Health Care (Philadelphia, PA)
- …to fill the position of **Clinical RN Nurse Manager** for our **Philadelphia, PA** Medicare Certified, Home Health office. Do you want to be part of providing care ... and ensuring that all home health nursing services comply with Medicare regulations, accreditation standards, and internal policies. This leadership role supports… more
- Humana (Harrisburg, PA)
- …verbal and written summation of research to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), ... + Perform ad hoc medical research for medical directors as needed for individual case reviews + Perform research regarding new CPT and HCPCS codes as required on… more
- Datavant (Harrisburg, PA)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and...reviewed by Datavant Human Resources and determined on a case -by- case basis. Depending on the state in… more
- Healthfirst (PA)
- …**8am-5pm or** **8:30am-5:30pm** **Duties and Responsibilities:** + Responsible for case development and resolution of clinical cases, such as: Pre-existing ... Update file documentation such as the file notes and case summary + Manage all duties within regulatory timeframes...(NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently… more