- St. Luke's University Health Network (Allentown, PA)
- …for an assigned number of patients under the supervision of the physician and/or Clinical Supervisor. JOB DUTIES AND RESPONSIBILITIES + Facilitate clinically focused ... as assigned by Supervisor. Case Management duties include individual assessments, utilization reviews, family or support interventions and assistance with discharge… more
- The Cigna Group (Philadelphia, PA)
- …oversight for all medical management functions, including case management (CM), utilization management (UM), and escalated case review. Ensures policies, procedures, ... out clinical community. The successful candidate will be a forward-thinking, flexible physician executive with a broad understanding of the healthcare industry, its… more
- Guthrie (Towanda, PA)
- …Assists with business plans, fiscal accountability, and clinical and resource utilization . Fosters change, and teamwork. Performs clinical duties of the patient ... experience or charge nurse experience desired Essential Functions: 1.RESOURCE UTILIZATION : + Considers factors related to safety, effectiveness, cost, and… more
- Guthrie (Sayre, PA)
- …of the denials and appeals team across all service lines (hospital, physician , outpatient, etc.) + Analyze denial trends and root causes; develop strategies ... to payer-specific appeal timelines and protocols + Collaborate with clinical, utilization management, billing, HIM, and coding teams to resolve medical necessity… more
- UPMC (Bethel Park, PA)
- …to reduce avoidable cancellations and improve throughput * Maximizing clinic utilization to enhance revenue capture and downstream service volumes By ensuring ... with no weekends or holidays! Responsibilities: + Manages daily operations at physician offices and clinic sites and coordinates work activities. Manages schedules… more
- Penn Medicine (Lancaster, PA)
- …verification, ordering of tests and coordination of applicable screening, diagnostic, physician office and outpatient hospital services. Capable of coordinating and ... patient acuity. Demonstrates skill to service both hospital and physician office patients, if necessary. + Supports inbound and...practices and able to access need for changes in utilization + Patient Care Safety + Greets and escorts… 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
- Penn Medicine (Philadelphia, PA)
- …their imaging needs. **Responsibilities:** + EQUIPMENT Responsible for the safe and correct utilization of US equipment and images to insure proper care and safety ... When in question, evaluates clinical history and consults with Radiologist/referring physician to determine appropriate study. Uses appropriate methods to confirm… more
- Penn Medicine (Lancaster, PA)
- …verification, ordering of tests and coordination of applicable screening, diagnostic, physician office and outpatient hospital services. Capable of coordinating and ... patient acuity. Demonstrates skill to service both hospital and physician office patients, if necessary. + Supports inbound and...practices and able to access need for changes in utilization + Greets and escorts patient and visitors to… more
- Fresenius Medical Center (Pittsburgh, PA)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... scheduling and payroll. PHYSICIANS: + Facilitates the application process for physician privileges and compliance with Fresenius Medical Care Medical Staff By-Laws.… more
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