- Prime Therapeutics (Harrisburg, PA)
- …and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing ... web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with management on regular… more
- Sharecare, Inc. (Harrisburg, PA)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description and ... patient and provider outcomes **Qualifications:** + Current multi-state/compact Registered Nurse licensure in state of residence is required, with ability… more
- Sharecare, Inc. (Harrisburg, PA)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- WellSpan Health (York, PA)
- …the utilization management process for preauthorization, concurrent review, denials and appeals for System acute care facilities. + Directs, coordinates, and ... + Works closely with Medical Director to identify trends in payor denials and appeals . + Serves as point of contact for System acute care utilization review issues… more