- slippery rock university (Slippery Rock, PA)
- …details for the position including any supplementary documentation and questions you should review before applying for the opening. To apply for the position, please ... you would like to bookmark this position for later review , click on the Bookmark link. To email this...academics, etc.) Coaches- *Conduct oversight and guidance for the Peer Coaches and ensure that they adhere to position… more
- Highmark Health (Harrisburg, PA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... implementation of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of medical… more
- Pfizer (Collegeville, PA)
- …Development Subteams + Conduct medical monitoring activities including eligibility assessment, data review and safety monitoring. + Lead peer -to- peer ... committee member in joint collaborations. + Collaborate with Clinical Scientists to review and interpret clinical data, identify key findings and implications, and… more
- Evolent (Harrisburg, PA)
- …reviews to be completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review… more
- Evolent (Harrisburg, PA)
- …reviews to be completed by the subject matter expert. . Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD … more
- Evolent (Harrisburg, PA)
- …+ Provides clinical rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering ... available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review… more
- Evolent (Harrisburg, PA)
- …reviews to be completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD … more
- Humana (Harrisburg, PA)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all ... physicians by phone to gather additional clinical information or discuss determinations through the Peer 2 Peer process, and in some instances these may require… more
- Pfizer (Collegeville, PA)
- …Development Subteams + Conduct medical monitoring activities including eligibility assessment, data review and safety monitoring. + Lead peer -to- peer ... committee members in joint collaborations. + Collaborate with Clinical Scientist to review and interpret clinical data, identify key findings and implications, and… more
- Pfizer (Collegeville, PA)
- …company objectives. + Conduct medical monitoring activities including eligibility assessment, data review and safety monitoring. + Lead peer -to- peer ... Guidance, Clinical Insights & Interpretation + Collaborate with Clinical Scientist to review and interpret clinical data, identify key findings and implications, and… more