- Devereux Advanced Behavioral Health (Malvern, PA)
- …answered YES, then consider joining our Devereux Advanced Behavioral Health team! Being a Utilization Review Specialist at Devereux has its Advantages! You ... need. Devereux's Children Behavioral Health Center (DCBHC) is currently seeking a Utilization Review Specialist to work at their acute psychiatric inpatient… more
- UPMC (Pittsburgh, PA)
- …in accordance with quality, timeliness, and efficiency standards. + Critically review pharmacy utilization management requests for approval/denial against ... UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team within the Pharmacy Services department. This is a… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Job Title: Medication History Specialist Medication Administration Location: 555 N Duke Street Department: Medication History ... entering patient medication histories into the hospital's information system for utilization by health care professional during the hospital encounter. JOB… more
- Medtronic (Philadelphia, PA)
- …connected, compassionate world. **A Day in the Life** The Surgical Robotics Utilization Team manages all aspects of system installation, start-up, customer training, ... period to ensure successful integration into the hospital's service lines. The utilization team members are seasoned professionals with in-depth knowledge of the… more
- Cardinal Health (Harrisburg, PA)
- Job Description **Senior Consultant, Product Sales Specialist - NPHS** **The territory covers Pennsylvania (Philadelphia, Pittsburgh and Allentown), Maryland ... Washington DC and Northeast Ohio (Cleveland)** The Product Sales Specialist is responsible for developing opportunities, selling, growing and maintaining… more
- Health Advocates Network (Harrisburg, PA)
- …certified at least twenty (20) hours per month. Demonstrate an understanding of utilization review processes. Basic computer skills to include, but not limited, ... Physician Specialist -NDC- Advanced **Pay Rate: ** $160 / hour...for the Department of Public Welfare. Resource will provide utilization and quality reviews of services for the Department.… more
- Datavant (Harrisburg, PA)
- …tools. The specialist serves as a key liaison between coding, billing, utilization review , case management, and payer relations to reduce denials and improve ... and life experiences to realize our bold vision for healthcare. The Specialist is responsible for identifying, analyzing, and resolving claim denials across the… more
- UPMC (Pittsburgh, PA)
- UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our Coding Department. This position will be a work-from-home position ... during standard business hours Monday through Friday. In this role, you will review clinical documentation within the medical record to ensure that all patient… more
- CVS Health (Harrisburg, PA)
- …We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist . The position will be a part of a specialized team who will ... all sales presentations. + Servicing of existing members and inquiries related to utilization of their product, benefits, etc. + Cross selling applicable products to… more
- PNC (Pittsburgh, PA)
- …contribute to the company's success. As a Portfolio Analytics & Strategy Specialist within PNC's Balance Sheet Analytics & Modeling Enterprise Credit Portfolio ... of credit quality, credit risk factor positioning & risk appetite utilization , and risk-adjusted performance quality & attribution, working in close coordination… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. Remote… more
- Cognizant (Harrisburg, PA)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, medical ... necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and third-party… more
- UPMC (Harrisburg, PA)
- …+ Facilitates pharmaceutical care services, direct patient care programs, medication utilization systems within assigned services and care areas to assure drug ... utilization activities are aligned with patient care needs, evidence-based...the management of medical emergencies + Provides discharge medication review , reconciliation, and counseling as appropriate + Provides pharmaceutical… more
- St. Luke's University Health Network (Sellersville, PA)
- …mental health/crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. Please ... may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and consults.… more
- WellSpan Health (Chambersburg, PA)
- …requests for service and/or assistance. + Provides a monthly operational review that includes monitoring product financial performance, operational challenges, and ... opportunities. + Evaluates the results, utilization , and value of established products and services to...employer database. + Provides reporting to employers on product utilization and outcomes. + Compiles data and prepares regularly… more
- BioFire Diagnostics, LLC. (Philadelphia, PA)
- …and environmental assessments. Prepares reports and summaries for senior staff review . + Assists in developing and implementing processes for preventative ... maintenance, equipment commissioning, and space utilization . + Assist with creating job plans for on-site...determine action plans for risk reduction + Ability to review the regulatory landscape to identify and mitigate non-compliant… more
- Evolent (Harrisburg, PA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Amergis (Pittsburgh, PA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more
- Aveanna Healthcare (Bala Cynwyd, PA)
- …through onboarding process to maintain relationship. - Assists the Onboarding Specialist , when necessary, with any onboarding requirements. - Coordinates the opening ... appropriately skilled clinician, and within insurance authorization. - Responsible to manage utilization of direct care team members based on patient needs as well… more
- Abbott (Pittsburgh, PA)
- …support and technical troubleshooting & elevate Level 2+ issues to service specialist to minimize overall cost to serve. Coordinate order; delivery; and billing. ... instrument analytical turnaround time (uptime/repair/maintenance) + Conduct customer business review (KPI reviews) + Manage customer relationship and thoroughly… more