- Genesis Healthcare (Mechanicsburg, PA)
- …Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical Operations Area Director in the hiring ... 8. Participates in and coordinates the timely completion of the annual merit review for therapy staff. 9. Assumes responsibility for hiring therapy staff (in… more
- Highmark Health (Harrisburg, PA)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Geisinger (Lewistown, PA)
- …occasionally cover weekends and call as part of a shared rotation. Don't worry, we'll review this in your interview. At least two (2) years of prior RN experience is ... services with the goal of optimizing the patient or member's health status. Manages utilization and practice metrics to further refine the delivery of care model to… more
- WellSpan Health (Chambersburg, PA)
- …and efficiently. + Identifies system/organizational processes which may affect effective utilization of resources, timely scheduling of tests, appropriate level of ... Thoroughly and accurately documents actions/communication surrounding discharge planning and/or utilization management in the medical record. + (BHU Only)… more
- Highmark Health (Harrisburg, PA)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- UPMC (Pittsburgh, PA)
- …the Insurance Services Division. Responsibilities: + Present complex members for review by the interdisciplinary team summarizing clinical and social history, ... healthcare resource utilization , case management interventions. Update the plan of care...case management interventions. Update the plan of care following review and communicate recommendations to the member and providers.… more
- Wellpath (Lemoyne, PA)
- …Nursing or Care Management Certification. + RN preferred. Experience + Previous utilization review and/or case management and pre-certification experience + ... difference** The Regional Care Manager (RCM) works collaboratively with the Utilization Medical Director, Regional Medical Directors, and Site Leadership to… more
- Highmark Health (Harrisburg, PA)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Oracle (Harrisburg, PA)
- …stays. + Knowledge of third-party payor rules and regulations. + 2-3 years of Utilization Review experience in a healthcare setting preferred; 1-2 years of ... college and AHIMA Certified RHIT credentials preferred + Certification in Utilization Review , case management, and healthcare quality preferred… more
- Penn Medicine (West Chester, PA)
- …and consultation. It also oversees service line VACs, supporting standardization, utilization , and new product assessments, while coordinating closely with supply ... + Meets regularly with hospital leadership and management to review product/equipment/supply issues and provide updates on resolution to known… more