- 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 is required. + Current State Registered Pharmacist license required. **PREFERRED QUALIFICATION(S)** : +… more
- UPMC (Pittsburgh, PA)
- …+ Knowledge of computer technology, quality assurance activities, DRG, Quality Insights/ Utilization review background is highly preferred. + Ability to ... communicate with staff, physicians, healthcare providers, and other healthcare system personnel in a professional and diplomatic manner required. **Licensure, Certifications, and Clearances:** + Certified Coding Specialist (CCS) OR Certified Registered Nurse… more
- Guthrie (Sayre, PA)
- …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... experience preferred. Essential Functions: + Support Care Management functions in Primary Care Practices + a. Actively manages a panel of high‐risk patients using motivational interviewing, shared decision making, and goal setting to increase patient/family… more
- LifePoint Health (Johnstown, PA)
- …care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff, and Discharge Planners assure that payer requirements are ... met and develop an individualized plan of care for our patients. The Case Management staff coordinates with the interdisciplinary team and community resources to maximize the patient's opportunity to succeed.** *Your experience matters* At Conemaugh Memorial… more
- LifePoint Health (Johnstown, PA)
- …staff competencies in all areas of care management to include utilization review , transition/discharge planning, social work services. Provide specialized ... expertise, ensure resource alignment with system-wide initiatives, and update appropriate parties on case management strategies, initiatives, outcomes, and issues. Successfully partner with physicians and others to ensure delivery of evidence-based care and… more
- UPMC (Mckeesport, PA)
- …required. + Knowledge and Skills:Expertise in care management, discharge planning and utilization review processes. + Ability to build credible and effective ... relationships with physician and executive leadershipUnderstanding of clinical, financial, and regulatory processes + Ability to prepare and critically analyze data, make appropriate recommendations toward resolution, and follow-through of identified action +… more
- CVS Health (Pittsburgh, PA)
- …consistent responses to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical expertise ... and business direction in support of medical management programs through participation in clinical team activities. Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs… more
- Penske (Langhorne, PA)
- …on location of accounts, volume, costs, customer requirements and private fleet utilization . Review daily orders for additional private fleet opportunities based ... on above requirements. **Schedule** : Monday - Friday 10:00PM - 7:00AM and Saturday 12AM - 10:00AM (Hours may vary depending on business needs) **Salary** : $60,400 - $81,400 - Position is bonus eligible up to 12% of the base salary **Major Responsibilities:**… more
- Penn Medicine (Philadelphia, PA)
- …monthly individual counseling services to patients.Conducts intakes, assessment and utilization review services.Ensures compliance with all documentation ... standards and standards regarding delivery of care.Attendance in individual and group counseling supervision. Credentials: + Basic Cardiac Life Support (Required) + Cert Alcohol and Drug Cnslr (Required) Education or Equivalent Experience: + Bachelor of Arts… 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