- KidsPeace Childrens Hospital (Schnecksville, PA)
- …telepsychiatry services based on the needs of the organization; d. Participating in utilization review activities including but not limited to development of ... Manual of Mental Disorders, written treatment orders, admissions on-call review for all legal commitment status documents and ...review for all legal commitment status documents and review and completion of routine and emergency Certificate of… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …and/or services based on the needs of the organization; + Participating in utilization review activities including but not limited to development of standards, ... history and physical examination, either written or dictated. This includes a review of the immunization status, allergies, past history, family history and… more
- YesCare Corp (Philadelphia, PA)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Other duties as ... Provides monthly in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as requested. Sponsors physician… more
- Wellpath (Collegeville, PA)
- …staff and ensure adherence to clinical protocols + Oversee chronic care clinics, utilization review , and quality improvement initiatives + Collaborate with the ... role in chronic care clinic oversight, pharmacy monitoring, and medical program review . **Key Responsibilities** + Provide direct medical care and document all… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …preferred. + Experience in a combination of home care management, case management review , utilization review , social service support, insurance reimbursement ... and patient advocacy, preferred. + In-depth understanding of health care insurance benefits, relevant state and federal laws and insurance regulations, highly desired. + Experience with data entry/computer literate skills, preferred. + Exhibits a high level of… more
- Cognizant (Harrisburg, PA)
- …+ Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. + Excellent problem-solving skill in ... team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI… more
- CVS Health (Blue Bell, PA)
- …organizational effectiveness. **Job Overview** Responsible for data analytics, reporting, and utilization review to inform business decision and optimize ... and non-technical stakeholders. + Helps establish and implement strategic review processes ensuring continuous improvement, compliance, and high-performance standards… more
- Prime Therapeutics (Harrisburg, PA)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... ranges from $74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page… more
- Cognizant (Harrisburg, PA)
- …experience. * Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. * Must be able to work with ... minimal supervision. * Good skills at problem resolution specifically related to healthcare claim adjudication. * Possess ability to work at a computer for extended periods. * Can work closely with other departments **Required Education and Experience** . High… more
- CVS Health (Lancaster, 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