- UPMC (Pittsburgh, PA)
- …healthy lifestyles, closes gaps in care, reduces unnecessary ER utilization and hospital admissions/readmissions, and manages social determinants of health. ... clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the plan of care… more
- UPMC (Pittsburgh, PA)
- …of the day-to-day operations of the authorization, denial management, and/or utilization review functions of UPMC Revenue Cycle, involving both clinical and ... + Function as a resource person for authorization, denial management and/or utilization review processes. + Assess and respond to organizational and customer needs… more
- Highmark Health (Pittsburgh, PA)
- …that supports excellence of care and achievement of optimal resource utilization . Also facilitates appropriate LOS, patient satisfaction and reimbursement for all ... denial trends with the care coordination teams, performance improvement teams, physicians/ physician advisor and third party payers. + Maintains a working knowledge… more
- Humana (Harrisburg, PA)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or… more
- Highmark Health (Harrisburg, PA)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... nature for profiling providers, assessing patient outcomes, studying cost and utilization trends and quantitative projections of industry and competitor performance,… more
- St. Luke's University Health Network (Bethlehem, PA)
- …to assure delivery of high quality nursing service in accordance with the physician 's orders and with the agency's programs and policies. Services are provided in ... to agency standards for the provision of quality care, appropriate service utilization , and compliance with third party payor requirements for reimbursement. 7.… more
- Penn Medicine (Philadelphia, PA)
- …use of internal resources, communication with interdisciplinary care team and Physician Advisor, with timely coordination of home care, DME, placements, hospice, ... quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources,… more
- St. Luke's University Health Network (Sellersville, PA)
- …to assure delivery of high quality nursing service in accordance with the physician 's orders and with the agency's programs and policies. Services are provided in ... to agency standards for the provision of quality care, appropriate service utilization , and compliance with third party payor requirements for reimbursement. +… more
- Penn Medicine (West Chester, PA)
- …and consultation. It also oversees service line VACs, supporting standardization, utilization , and new product assessments, while coordinating closely with supply ... exceeding patient and customer expectations through the selection, implementation, and utilization of products and technology. + Analyzes and utilizes employee and… more
- ChenMed (Philadelphia, PA)
- …treatment, development of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ... practitioner in collaboration and consultation with a licensed patient care team physician . Practices in accordance with a written or electronic practice agreement.… more