- Amergis (Pittsburgh, PA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more
- UPMC (Pittsburgh, PA)
- …position will be fully remote! In this role, the DRG Specialist II will review clinical documentation within the medical record to ensure that all patient resource ... utilization , diagnostic complications and co-morbidities have been coded in...that were performed during an episode of care. + Review and evaluate focused UPMC DRG medical records for… more
- UPMC (Pittsburgh, PA)
- …role requires three years of coding experience. In this role, you will review clinical documentation within the medical record to ensure that all patient resource ... utilization , principal diagnosis, secondary diagnoses, and PCS procedures have...coding guidelines, third-party payer and OIG regulations. **Responsibilities:** + Review and evaluate focused UPMC DRG medical records for… more
- WellSpan Health (York, PA)
- …individual staff to ensure safe quality care, progress towards goals, and proper utilization of services. * Provides after-hours and on-call staff support as well as ... and development of new clinical policies and the regular review and updating of existing clinical policies as indicated.*...Care in a professional manner. * Responsible for efficient utilization of all resources including, but not limited to,… more
- Penn Medicine (Philadelphia, PA)
- …quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources, ... community resourcesParticipates and drives accountability in daily interdisciplinary meetings Utilization Management:Adheres to guidelines to satisfy 3rd party payer… more
- Guthrie (Sayre, PA)
- …leadership and autonomy in nursing practice. Preferred experience with care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... and services available to patient/family when needed. The Care Coordinator-Transitional Care nurse notifies the primary care provider of any urgent patient needs.… more
- Geisinger (Port Matilda, PA)
- …patient's reason for visit, weight, vital signs, visit screening information, medication review , and pertinent information for provider. + Sets up examination and ... substances only to ensure adequate supply levels, verify expiration dates, document utilization , optimize organizational efficiency and space utilization . + May… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. + Adheres to the policies, procedures, rules,… more
- Penn Medicine (Lancaster, PA)
- …Pennsylvania Board of Nursing. + Bachelor's degree in Nursing BSN . + Knowledge of utilization review or managed care. + Care management experience in a managed ... Coordinates care across the continuum inpatient outpatient community to assure appropriate utilization of clinical and community resources. + Oversees and guides the… more
- Geisinger (Bellefonte, PA)
- …patient's reason for visit, weight, vital signs, visit screening information, medication review , and pertinent information for provider. + Sets up examination and ... substances only to ensure adequate supply levels, verify expiration dates, document utilization , optimize organizational efficiency and space utilization . + May… more