- Humana (Harrisburg, PA)
- …where your clinical expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager , you will spearhead audit and validation ... relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management....skills to make an impact** **Required Qualifications** + Registered nurse (RN). + 5 or more years of clinical… more
- Fresenius Medical Center (Enola, PA)
- …and any other treatmentrelated data into systems. + Ensures regulatory, compliance, and audit activities are accomplished on time. + Orients and supports new staff ... and provides ongoing education, ensuring compliance with all risk management initiatives, including in-center staff. + Participates in Business Unit initiatives, projects, and audits as directed. + Performs other related duties as assigned. **PHYSICAL DEMANDS… more
- Genesis Healthcare (Camp Hill, PA)
- Overview POSITION SUMMARY: Under the direction of the RN Nursing Supervisor, Unit Manager , ADON or ADON - Unit, or Director of Nursing ( Nurse Leader), the ... within the scope of practice defined by the State Nurse Practice Act and delegates aspects of patient care...via the Integrity Hotline. 4. Cooperates with monitoring and audit functions and investigations. 5. Participates, as requested, in… more
- Sunrise Senior Living (Lafayette Hill, PA)
- …be a part of.** **Job ID** 2025-233309 **JOB OVERVIEW** The LPN Medication Care Manager is responsible for providing the highest degree of quality care and services ... medication updates from Resident Care Director (RCD) or Wellness Nurse . + Administer, assist with, and observe medications and...supervisor. + Count all narcotics with another Medication Care Manager (MCM) or Lead Care Manager (LCM)… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... monitors, intervenes/resolves and reports clinical denials/appeals and retrospective payer audit denials. Collaboratively formulates plans of action for denial… more
- CVS Health (Harrisburg, PA)
- …travel if a plan sponsor requests pharmacist attendance for an onsite visit/assessment/ audit . The Pharmacy Program Manager role includes: -Collaborate with an ... with heart, each and every day. The Pharmacy Program Manager is an individual contributor (non-people manager )...interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to… more
- Highmark Health (Harrisburg, PA)
- …meets with all compliance, regulatory and contractual requirements. Conducts ongoing audit review programs, develops tools to assess current outcomes and trends ... Systems functions. Responsible for after-action items as outcome of Quarterly State Audit Reviews, Annual MERCER Review and NCQA Review. Develops ongoing educational… more
- ICW Group (Philadelphia, PA)
- …goals. **ESSENTIAL DUTIES AND RESPONSIBILITIES** Provides oversight for all vended Nurse Case Management (NCM) products, including Field Case Management (FCM) and ... Nurse Triage programs. + Builds strong relationship with external...containment program support. + Provides support to claims and audit teams as needed for medical management oversight results… more
- Penn Medicine (West Chester, PA)
- …: + SUPERVISION: Directly and/or indirectly supervising the clinical research nurse (s), clinical research coordinators(s), data manager (s) and research ... including blood, urine and tissue samples, participate in initiation, monitoring, audit and close-out visits, coordinate study team meetings, disease site and/or… more
- Heritage Ministries (Conneautville, PA)
- …will work in conjunction with the Management Company's Clinical Reimbursement Case Manager , acting as a liaison to finance/billing, and assisting as defined within ... assess appropriate setting of ARD's, assure therapy and clinical service capture, audit for direct care documentation of ADL's, and clinical/nursing documentation of… more