- UPMC (Cranberry Township, PA)
- …training new associates and provide ongoing education and communication to staff. + Review to ensure 100% compliance with uLearn requirements is met. + Evaluates ... make independent decisions. + Know insurance pre-certification/pre-authorization, Managed Care, Medicare /Medicaid and Commercial insurance plans. + Prior working experience… more
- Fresenius Medical Center (Charleroi, PA)
- …the designated clinical application accurately and in a timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and ... assist" devices for the heavier items. **EDUCATION** + Center for Medicaid/ Medicare Services (CMS)-approved state and/or national certification or High School… more
- WellSpan Health (Waynesboro, PA)
- …through interdisciplinary collaboration, Shared Decision Making activities including peer review . Integrate Shared Decision Making by unit committee membership or ... health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and… more
- Humana (Harrisburg, PA)
- …and communicates information regarding actuarial/business risks across the organization. Provides peer review and counsel on a wide variety of company, industry, and ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- WellSpan Health (Lebanon, PA)
- …through interdisciplinary collaboration, Shared Decision Making activities including peer review . Integrate Shared Decision Making by unit committee membership or ... health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and… more
- Humana (Harrisburg, PA)
- …for a health plan. + 5+ years HEDIS and quality measures and ability to review and interpret cost and quality data to drive improvements. + Experience working with ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Prime Therapeutics (Harrisburg, PA)
- …Qualifications** + Previous experience with RxClaim + Previous experience with Medicare or Medicaid Every employee must understand, comply with and attest ... ranges from $81,000.00 - $138,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page… more
- AmeriHealth Caritas (Philadelphia, PA)
- …organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and practice initiatives ... preferred. + Minimum of 3 years of utilization management experience in a Medicaid, Medicare , dual eligible or commercial health plan. + Minimum of 5 years of… more
- Robert Half Finance & Accounting (Philadelphia, PA)
- …bank reconciliation reports. + Aid management in preparing UDS and Medicaid/ Medicare cost reports. + Detect control deficiencies and suggest corrective measures. ... + Manage and reconcile daily cash transaction records. + Draft and review closing journal entries. + Conduct thorough analysis of aging accounts receivable balances.… more
- WellSpan Health (Mount Gretna, PA)
- …appropriate solutions to crisis calls and service inquiries. + Visual ability to review and prepare written information and to observe patient behavior is required. ... health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and… more