- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …to work and adjust to different environments. Knowledge of Interqual and utilization review standards. Experience in clinical documentation within electronic ... required. Experience in Care Coordination, Discharge Planning, Clinical Documentation and Utilization Review preferred. Strong verbal, written and leadership… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review … more
- Highmark Health (Monroeville, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions,… more
- Guthrie (Sayre, PA)
- …operational aspects for Care Coordination including, but not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical ... knowledge in and experience of payer contract language, as it relates to utilization management. Can navigate through the requirements imposed by all payers. Prior… more
- Health Advocates Network (Harrisburg, PA)
- …setting, behavioral health setting, drug and alcohol setting, managed care, quality management/ utilization review or other related clinical experience; or An ... medical assistance (MA), health care services, human services, long term care, utilization review , or knowledge of home care Knowledge of and familiarity with… more
- Sedgwick (Harrisburg, PA)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug… more
- Highmark Health (Monroeville, PA)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to the policies,… more
- Genesis Healthcare (York, PA)
- …to seven years of clinical nursing experience is required. Prior experience in utilization review , case management or discharge planning is required. Prior ... of owned and managed centers is effectively managing resource utilization , improving clinical outcomes, maximizing reimbursement, complying with contractual… more