- CenterWell (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Care Delivery Call Quality Professional works within the PCO Growth and Retention group. ... and monitoring the Tele Sales Agents who are responsible for converting Medicare eligible callers to patients. The Care Delivery Call Quality Professional is… more
- Cognizant (Harrisburg, PA)
- …Necessity Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review ... denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing… more
- Genesis Healthcare (PA)
- … health *Employee Foundation to financially assist through unforeseen hardships * Health , Dental, Vision, Company-paid life insurance , 401K, Paid Time Off ... to improve outcomes, enhance care coordination, and drive success in the Medicare Shared Savings Program. We help long-term care providers deliver high quality,… more
- Aveanna Healthcare (Kane, PA)
- …FriendBack Job Details Requisition #: 203494 Location: Kane, PA 16735 Category: Home Health Aide Salary: $16.00 - $18.00 per hour Position Details PRN 8am-8pm ... hygiene, etc. Assist Individuals in living an everyday life. Ensure the health and safety of the Individual. Respite only requirements: For out-of-home overnight… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... BSN or Bachelor's degree in a related field + Health Plan experience + Experience in utilization management or...criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Technology Solution Implementation Professional delivers new technological solutions to ... Operations in electronic transmissions set-up for state regulatory partners, health information exchanges, and vendor partners. **Responsibilities:** Works with ETL… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Associate Director, HEDIS Operations of Non-Standard Supplemental for business operations ... of, numerous strategies required to ensure success for our Medicare Stars and Medicaid LOBs. The ideal candidate for...data to identify trends and opportunities for improved member health and measure compliance + Internal and external partnerships… more
- UPMC (Pittsburgh, PA)
- …needs through other sources, including services provided under Medical Assistance , Medicare or private insurance and other community resources. + Actively ... 'block__field--wide-rich-text' : 'block__field--edit'}" id="descriptionInt-container" html: $component.getFieldValue($data)" id="descriptionInt-value" formfieldid="descriptionInt" UPMC Health Plan is seeking a full-time CHC Service Coordinator,… more
- Robert Half Finance & Accounting (Carlisle, PA)
- …plays a critical role in optimizing billing, coding, claims processing, insurance verification, and collections to ensure compliance and maximize reimbursement. The ... efficiency. Responsibilities: * Oversee the revenue cycle processes for Medicaid, Medicare , managed care, commercial payers, and sliding fee programs. * Establish… more
- US Tech Solutions (Pittsburgh, PA)
- …calls. You will take inbound calls and answer questions regarding prescription insurance , medication coverage and mail order prescriptions so that our members better ... will offer the solutions needed to help simplify their health care experience. You will have the opportunity to...the provider and member regarding their prior authorization/ PBM/ Medicare . + Review and process prior authorization requests by… more