- STG International (Pottsville, PA)
- …*Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... activities. *Ensure consistency in evidence-based practice standards across the CBOC's. *Implement and attend provider huddles to assure situational awareness of clinic operational limitations and daily work planning. *Function as a director for the CLIA… more
- Geisinger (Pottsville, PA)
- …professional determinations regarding medications and various drug interactions, drug utilization review , generic substitution, and accurately filling and ... dispensing the prescription. + Process prescriptions by receiving the prescription via telephone from the physician or in person from the patient, reviewing it against the medication profile for possible sensitivities and drug interactions, and checking it for… more
- UPMC (Pittsburgh, PA)
- …Prior Clinical Documentation Improvement (CDI) experience. + Background in Quality Assurance, Utilization Review , or Quality Insights. + Advanced knowledge of ... DRGs, PPS, and coding guidelines. + Familiarity with quality metrics and compliance standards. Key Skills + Excellent interpersonal and communication skills. + Analytical thinking and attention to detail. + Ability to work collaboratively across… more
- CVS Health (Paoli, PA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients' prescriptions are filled promptly, safely, and accurately, and we are providing caring service that… more
- Penn State Health (Reading, PA)
- …in patient, student and staff teaching programs; participating in drug utilization review activities; performing clinical pharmacy services as needed; ... and accepting on-call responsibilities. **MINIMUM QUALIFICATION(S):** + Bachelor of Science degree in Pharmacy from an accredited college of pharmacy required. + Current State Registered Pharmacist license required. **PREFERRED QUALIFICATION(S):** + Previous… more
- Deloitte (Philadelphia, PA)
- …nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and ... health IT preferred + Knowledge of Medicare reimbursement system and coding structures preferred + In-depth knowledge and experience in medical terminology, medical coding, and ICD-10-CM/PCS, IPPS payment system is a plus' + Experience in quality measurement,… more
- Wellpath (Coal Township, PA)
- …and procedures for infirmary admissions, emergency room transfers, and the utilization review process for specialty referrals while maintaining responsibility ... for individual judgments and actions. + Maintains patient confidentiality and privacy in accordance with accepted practices for incarcerated individuals and participates in facility committees, such as Pharmacy and Therapeutics and Medical Audit Committee, as… more
- Penn Medicine (Lancaster, PA)
- …Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for patients by ... thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating medical records to… more
- Cognizant (Harrisburg, PA)
- …and retro-authorization as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral, preauthorization, medical ... necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and third-party… more
- Highmark Health (Pittsburgh, PA)
- …in planning/marketing strategy to ensure referral sources. + Participates in peer utilization and/or review and assists in coordination of related quality ... assurance efforts to improve provision of service. Updates clinical expertise to ensure treatment skills are current. QUALIFICATIONS: Minimum + Master's degree in Social Work, Counseling, Psychology, or related field. + 3 to 5 years of prior job-related work… more