- WellSpan Health (York, PA)
- …members, referral sources and external payers regarding the effective and efficient utilization of program service and available resources as well as the benefit ... and need for inpatient level rehabilitation services. Assessment includes chart review , clinical physical assessment and interaction with the physician, nurses and… more
- Penn Medicine (Radnor, PA)
- …+ Manage pay practices including accurate timecard review and approval, review and manage all overtime utilization + Assists with the implementation ... to enable high performance of team and individuals Credentials: + Registered Nurse - PA (Required) + BLS/ACLS/PALS per specialty (Required) Education or Equivalent… more
- Penn Medicine (Philadelphia, PA)
- …optimal reimbursement for the hospital for services provided. Responsibilities: + Review chemo schedule in advance and determines patients insurance requirements for ... to patient arrival. Assess information for appropriateness of setting and utilization of resources to optimize patient outcomes and cost effectiveness. Maintain… more
- CVS Health (Harrisburg, PA)
- …and supporting the implementation of care plans to promote effective utilization of health services service. Promotes/supports quality effectiveness of Healthcare ... Services. Responsible for initial review and triage of Care Teams tasks. -Identifies principle...for health care service delivery under the direction of nurse or medical direction of medical direction in the… more
- UPMC (Pittsburgh, PA)
- …implemented. + Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues. + Preserve confidentiality of the member. + ... Make recommendations for changes when indicated. + Assist in the development and review of training materials for staff, other UPMC Health Plan departments, and… more
- St. Luke's University Health Network (Allentown, PA)
- …outpatient denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. JOB ... visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state of Pennsylvania or… more
- UPMC (Pittsburgh, PA)
- …the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals ... all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria...and Clearances:** + Current licensure as a Registered Professional Nurse either in the state where the facility is… more
- Fresenius Medical Center (Philadelphia, PA)
- …barriers to quality improvement. This includes promoting the adoption and utilization of Medical Advisory Board Recommended Algorithms and Standing Orders, clinical ... quality improvement tools and electronic applications. + Performs desk review of facility Quality Assessment and Performance Improvement (QAPI) documentation… more
- Veterans Affairs, Veterans Health Administration (Philadelphia, PA)
- …on current administrative guidelines. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic ... of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical… more
- UPMC (Mechanicsburg, PA)
- …leadership required.KNOWLEDGE AND SKILLS:Expertise in care management, discharge planning and utilization review processes. Ability to build credible and ... Worker (LSW) OR Other Healthcare Professional Licenses for Discharge Planning OR Registered Nurse (RN) *Current licensure either in the state where the facility is… more