- Humana (Harrisburg, PA)
- …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... of our caring community and help us put health first** The Bilingual Telephonic UM Coordinator / UM Administration Coordinator 2 provides non-clinical support for… more
- Sedgwick (Harrisburg, PA)
- …line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and… more
- Highmark Health (Harrisburg, PA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- Sharecare (Harrisburg, PA)
- …and objectives of the Disease Management program by providing high quality telephonic and omni - channel support in an appropriate, efficient and cost-effective ... nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- UPMC (Pittsburgh, PA)
- …will support Shadyside Family Practice onsite in Shadyside and may provide telephonic support to other practices. The position will work standard daylight hours, ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
- UPMC (Pittsburgh, PA)
- …RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... daylight hours, with occasional Saturday shifts required. This is a primarily telephonic role with electronic responsibilities. While this role does work remotely,… more
- Guthrie (Sayre, PA)
- …leadership and autonomy in nursing practice. Preferred experience with care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... On Bonus For Qualified RNs! Summary: The Care Coordinator-Transitional Care provides telephonic outreach to all patients that have been discharged from an inpatient… more
- CVS Health (Wellsboro, PA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... appropriate under the direct supervision of a licensed pharmacist + Taking telephonic prescriptions from the prescriber, and calling the prescriber to clarify… more