- Humana (Harrisburg, PA)
- …enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ million ... health outcomes for some of our most vulnerable members. The Director, Physician leadership will lead Medical Directors performing utilization management for… more
- YesCare Corp (Philadelphia, PA)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Other duties as ... expertise. **ID** _2024-20068_ **Job Locations** _US-PA-Philadelphia_ **Category** _Physician & Physician Leadership_ **Position Type** _Regular Full -time_ **Shift… more
- Guthrie (Sayre, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …to work and adjust to different environments. Knowledge of Interqual and utilization review standards. Experience in clinical documentation within electronic ... required. Experience in Care Coordination, Discharge Planning, Clinical Documentation and Utilization Review preferred. Strong verbal, written and leadership… more
- Guthrie (Sayre, PA)
- …operational aspects for Care Coordination including, but not limited to Case Management, Utilization Review (UR), Utilization Management (UM), and Medical ... knowledge in and experience of payer contract language, as it relates to utilization management. Can navigate through the requirements imposed by all payers. Prior… more
- Penn Medicine (Lancaster, PA)
- …living your life's work? Job Description **LOCATION** : Lancaster, PA **HOURS** : Full -Time, Day Shift, 40 hours/week. Shifts vary from 8:00am to 4:30pm and 8:30am ... patient/provider office visits, nurse visits, and telephone triage. Collaborates with Physician and Advanced Practice Providers (APPs) to provide patient care and… 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 ... for all identified patients. + e. Collaborates with patient, physician , and other care team members in assessing the...Employer. The Guthrie Clinic is a non-profit, integrated, practicing physician -led organization in the Twin Tiers of New York… more
- Guthrie (Sayre, PA)
- …program development include assisting with feasibility, site selection, IRB document review , and corresponding with investigators, IRB, and sponsors. + Coordinate ... sponsor via the appropriate sponsor case report form submission process after review for accuracy and validation of information is obtained. Maintain study… more
- Guthrie (Sayre, PA)
- …in short/long range facilities planning, construction, major rehabilitation, and space utilization programs. * Experience and successes in communicating and managing ... to reduce cost and improve response time. 14. Oversees the department, review , approval, and implementation of department policies and procedures on safety, risk… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... health first** $10K SIGN ON BONUS **Work Schedule** : Full -time/40 Hours **Position Type** : On-site **Branch Location** :...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more