- ChenMed (Philadelphia, PA)
- …assess and record patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with inpatient staff for possible ... patient is in SNF, in conjunction with the post-acute physician , coordinates the transition to a lower level of...required + A minimum of one (1) year of utilization review and/or case management, home health,… more
- UPMC (Pittsburgh, PA)
- …face-to-face assessments that include a clinical assessment and treatment, a review of the medical, functional, behavioral, pharmaceutical, and social needs of ... the member, including instrumental activities of daily living. Review UPMC Health Plan data and EMR data, and documentation in the member's electronic health records… more
- UPMC (Pittsburgh, PA)
- …a full-time Clinical Care Manager to support our partnership with various physician practices. This role will support Shadyside Family Practice onsite in Shadyside ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
- Penn Medicine (Philadelphia, PA)
- …conducts utilization management activities, communication with insurers, team, and physician advisor. Discharge planning activities such as : home care, DME, ... use of internal resources, communication with interdisciplinary care team and Physician Advisor, with timely coordination of home care, DME, placements, hospice,… more
- Humana (Harrisburg, PA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Harrisburg, PA)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Highmark Health (Monroeville, PA)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to the policies,… more
- Penn Medicine (Philadelphia, PA)
- …must be a seasoned med/surg nurse with a minimum of 5 years' experience in Utilization review and 3 years of experience in the Transfer Center.** Summary: + ... use of internal resources, communication with interdisciplinary care team and Physician Advisor, with timely coordination of home care, DME, placements, hospice,… more
- WellSpan Health (Lebanon, PA)
- …the provider and the patient concerning patient. + In collaboration with Physician /APP, reinforces health education, counseling, and advice to patients and families ... will direct patient/caller to an acceptable alternative venue of care. Seeks Physician /APP advice appropriately. + Tracks, reviews, and monitors the follow-up of… more
- LifePoint Health (Johnstown, PA)
- Conemaugh Physician Group is seeking a full-time Practice Manager for the CPG East Hills Primary Care and Medwell. The primary responsibilities of the Practice ... Pennsylvania, serving over a half-million patients each year through the Conemaugh Physician Group and Medical Staff, a network of hospitals, specialty clinics and… more