- AmeriHealth Caritas (Newtown Square, PA)
- ; Role Overview Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... cases are escalated to the Medical Director for further review . The reviewer independently applies medical and...timely engagement of case management of all transplant members. Conduct utilization management … more
- CSL Behring (King Of Prussia, PA)
- …analysis and reporting from the Centre of Excellence and ensuring any Category Management roles within the team also review and manage Supplier performance ... innovation, customer service, compliance and quality. Establish and Maintain Effective Category Management and Bid Management : Drive value from the regional… more
- CSL Behring (King Of Prussia, PA)
- …East Region, Birmingham, N. The Area Manager is responsible for promotion and utilization of CSL Behring products and for managing all aspects of territory business ... of technical product and disease state information, and effective territory management skills. Develop and implement territory business plans consistent with… more
- CSL Behring (King Of Prussia, PA)
- …with corporate plans. Actively participate as a member of the Regional Management team. Main Responsibilities and Accountabilities Meet regional sales goals by ... Training and Marketing, Medical Affairs and Customer Service. Responsible to assure field utilization of CRM system to track and monitor sales activity and results… more
- Highmark Health (Harrisburg, PA)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- CSL Behring (King Of Prussia, PA)
- …thorough depth and breadth of customer interaction at various (senior management and operational) levels of the customer's organization, builds and maintains ... provider levels. + Secures meetings with appropriate customer personnel to review the clinical and reimbursement information and adopt appropriate treatment… more
- Fresenius Medical Center (Dallas, PA)
- …the patient. + Ensure education of the patient regarding quality measures, transplant options, modality awareness, and access care, including catheter reduction and ... the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member...+ Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic,… more
- CSL Behring (King Of Prussia, PA)
- …analysis and reporting from the Centre of Excellence and ensuring any Category Management roles within the team also review and manage Supplier performance ... innovation, customer service, compliance and quality. _Establish and Maintain Effective Category Management and Bid Management :_ + Drive value from the regional… more
- CSL Behring (King Of Prussia, PA)
- …to CMS guidance, federal regulations, and industry standards. Assist with review and understanding the financial impacts of new/proposed government programs and ... and compliance support for Audit, Legal or Finance as requested 9. Provide management oversight on the records supporting the disclosure of data to federal and… more
- Fresenius Medical Center (Pittsburgh, PA)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
