- CVS Health (Harrisburg, PA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST zones.… more
- Intermountain Health (Harrisburg, PA)
- …specialty care settings or previous appeals experience. + Demonstrated experience in utilization review and/or case management , hospital insurance billing, third ... **Job Description:** The RCO Audit & Appeals RN Consultant is responsible for consulting on clinical Appeals and Audits for Intermountain Health. The Audit/Appeals… more
- Highmark Health (Camp Hill, PA)
- …+ Performs as the clinical subject matter expert for clinical, quality, care, utilization , high cost claim and population health management as the part ... stay current on health, wellness, productivity, risk and care management trends in the market place in order to...or CERTIFICATIONS** **Required** (any of the following) + Registered Nurse (RN) + Physician Assistant License - PA +… more
- Penn Medicine (Philadelphia, PA)
- …life's work? Penn Presbyterian Medical Center (PPMC) has an outstanding opportunity for a Nurse Unit Based Educator to join the HVICU team and work alongside some of ... commitment to your professional growth and development. Summary: + The Clinical Nurse Educator (CNE) practices within the UPHS professional practice model and… more
- ChenMed (Philadelphia, PA)
- …for health: The PCP acts as a health coach, rather than just a consultant for sickness, by helping patients set short and long-term health goals, partners with ... ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required that promote… more
- Commonwealth of Pennsylvania (PA)
- …Bureau / Division Code 00211550 Bureau / Division Bureau of Quality Management and Data Review/Clinical Review Division Worksite Address 303 Walnut Street Worksite ... Do you enjoy learning and implementing new software applications to increase utilization review efficiencies and reporting? The Office of Mental Health and Substance… more
- UPMC (Pittsburgh, PA)
- …documentation within the medical record to ensure that all patient resource utilization , principal diagnosis, secondary diagnoses, and PCS procedures have been coded ... to coding and compliance guidelines. + Meet with coding management as scheduled to review progress, discuss problems, and...System and DRG selection; OR specific knowledge as a consultant in Medical Record coding and DRG assignment required.… more