- UPMC (Pittsburgh, PA)
- …professional and institutional providers of care. + Ability to implement programs of quality care analysis, peer review , and professional education. ... related to Psychological Services across the Behavioral Health service line. Assure the quality and efficiency of the health care delivered to members as well as… more
- Penn Medicine (Lancaster, PA)
- …without reasonable accommodation to perform the following duties: + Complete chart review and communicate patient status medical needs with insurance companies in ... patient class throughout patient stay by using Industry standard review tools, department policies, and critical thinking. + Occasionally...to follow up on authorization related denials. + Facilitate Peer to Peer appeal processes and complete… more
- Penn Medicine (Philadelphia, PA)
- …are complete; perform investigations under direction of in-house counsel or hospital peer review committees; prepare reports of adverse events resulting in ... necessary. + Performs investigations pursuant to direction of in-house counsel or hospital peer review committees, often followed by written reports, of adverse… more
- Evolent (Harrisburg, PA)
- …as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Aids and acts as a resource to Initial ... reviews to be completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers,… more
- Evolent (Harrisburg, PA)
- … Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with ... + Provides clinical rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering… more
- University of Pennsylvania (Philadelphia, PA)
- …Dean for Global Engagement, the Assistant Dean articulates admissions strategies for the program and participates in the representation of Penn Carey Law to a host ... aid and matriculation strategies, build classes of deep academic quality and broad geographical diversity. + Using a deep...sound analysis of complex data, recommend to the Dean program goals and admissions targets. + Design and manage… more
- Fresenius Medical Center (Willow Grove, PA)
- …values and customer service philosophy. Adheres to the FMCNA Compliance Program , including following all regulatory and FMS policy requirements. Ensure provision ... of quality patient care while maintaining cost-effective clinical operations in...programs. Adheres to all requirements of the FMCNA Compliance Program , and FMS patient care and administrative policies as… more
- Publicis Groupe (Philadelphia, PA)
- …collaborating with other content developers. The incumbent is responsible for the quality , scientific and medical accuracy and integrity, and timeliness of assigned ... writing, editing, faculty approvals, and production; and is responsible for the quality , scientific and medical accuracy and integrity, and timeliness of assigned… more
- NTT America, Inc. (Harrisburg, PA)
- …cause. + Ability to develop and take new design concepts through detailed design, peer review , executive review , construction, and operation. + Thorough ... quality and timeliness of the AE's performance. + Review and approval of consultant invoices. + Interaction with...AE Consultants. + Contributes to the continuous development of program standards and specifications. + Provide guidance to all… more
- CVS Health (Harrisburg, PA)
- …providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews ... and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This...Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level… more