- Highmark Health (Wexford, PA)
- …services to patients, families, and other external customers upon arrival. Assume clinical and financial risk of the organization when collecting and documenting ... information through payor contacts via telephone, online resources, or electronic verification systems utilizing accurate plan code and COB order. Obtains limited … more
- Beth Israel Lahey Health (Boston, MA)
- …materials. Participates in patient rounds and case conferences. 5. Updates clinical knowledge and skills through consultation, formal and informal education, and ... review of literature for self and clinical team. Provides leadership for process improvement related to...- Basic Life Support Certificate 5. Experience with computer systems required, including web based applications and some Microsoft… more
- Atlantic Health System (Morristown, NJ)
- …quality healthcare delivery across the care continuum. 2. Utilizes established clinical pathways to facilitate comprehensive and consistent chronic disease specific ... proficiency and compliance with regulatory requirements. 15. Assists in orientation and training of new staff as requested. ?Participates in provider outreach and… more
- Carle Health (Peoria, IL)
- …community resources, as needed, such as homemaker/PA service, emergency alert systems , home delivered meals, durable medical equipment, food pantries, utility ... management information as needed. Key Accountability + Participates in in-service and competency training . + Prepares special reports as needed. + Meets clinical … more
- WestCare Foundation (Fresno, CA)
- …resolved at the program level; + Ensure that the agency systems for collecting statistical data necessary for program evaluation, planning, justification ... and staff training are collected as required; + Fill in for...+ Embrace and embody the mission, vision, guiding principles, clinical vision and goals of WestCare Foundation; and +… more
- OhioHealth (Columbus, OH)
- …written. SPECIALIZED KNOWLEDGE 3 months or more of related experience and/or training ; or equivalent combination of and experience. DESIRED ATTRIBUTES 6 months or ... with spreadsheets, databases and word processor software and organization systems / applications ( Workday, Microsoft TEAMS, EPIC). BEHAVIORAL COMPETENCIES LEADERSHIP… more
- CVS Health (Sacramento, CA)
- …standard processes to complete. Act as a subject matter expert by providing training , coaching, or responding to complex issues. May have contact with outside plan ... accuracy and appropriateness of a benefit/administrative denial. Can review a clinical determination and understand rationale for decision. Able to research claim… more
- Fallon Health (Worcester, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... problems and assists in resolving employee system issues. * Assists with user training . * Assists in providing system access. * Provides basic reporting assistance… more
- Highmark Health (Buffalo, NY)
- …authorization case in Highmark's Utilization Management system for Prior Authorization clinical review, status research, etc. Ensures all accurate information is ... or pharmacy for all inbound Prior Authorization requests.Use multiple software systems and various resource sites to determine member plans and requirements… more
- Highmark Health (Buffalo, NY)
- …case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate information is entered at the onset of ... or pharmacy by phone in some areas of the organization.Use multiple software systems and various resource sites to determine member plans and requirements.Gather all… more