- Select Medical (Hummelstown, PA)
- …Employer, including Disabled/Veterans_ Apply for this job (https://jobs-selectmedicalcorp.icims.com/jobs/347230/ director -of- quality - management inpatient ... joint venture with Select Medical & Penn State Health** ** Director of Quality Management ** **(DQM)**...+ Customizable health insurance packages **Who We Are** Our inpatient rehabilitation hospital is committed to providing exceptional and… more
- Datavant (Harrisburg, PA)
- …life experiences to realize our bold vision for healthcare. As an ** Inpatient Auditing Specialist** you will be instrumental in addressing consulting and educational ... needs related to coding quality , compliance assessments, external payer reviews, coding education, interim coding management , and coding workflow operations… more
- Select Medical (Mechanicsburg, PA)
- …insurance verification? Read more to unlock your future career!_** Our inpatient rehabilitation hospital is committed to providing exceptional and compassionate care ... partnership between Select Medical and Pinnacle Health. This hospital provides inpatient physical rehabilitation for patients who are medically complex and in… more
- CenterWell (Harrisburg, PA)
- …with prior experienceparticipatingin teams focusing on transitions of care, quality management ,utilizationmanagement, case management , discharge planning ... toadaptand the courage to innovate. **Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical … more
- Humana (Harrisburg, PA)
- …participation in care management . The clinical scenarios arise from outpatient, inpatient or post-acute care environments. The Medical Director will have ... skills, with prior experience participating in teams focusing on quality management , utilization management , case...Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care… more
- Humana (Harrisburg, PA)
- …analytic and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... communication of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from inpatient or… more
- Humana (Harrisburg, PA)
- …care, quality metrics, population health, and disease or care management . The Behavioral Health Medical Director may develop procedures, processes, ... help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or...skills, with prior experience participating in teams focusing on quality management , utilization management , case… more
- Humana (Harrisburg, PA)
- …with prior experience participating in teams focusing on quality management , utilization management , and acute inpatient rehabilitation. Preferred ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Harrisburg, PA)
- …analytic and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare..., depending on the line of business. The Medical Director conducts Utilization Management or clinical validation… more
- Humana (Harrisburg, PA)
- …+ Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services + Maintain accountability for productivity, quality , and ... of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Humana (Harrisburg, PA)
- …members of the Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including ... community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on...subject matter contribution Preferred Qualifications + Experience in an inpatient environment and/or related to care of a Medicare… more
- Humana (Harrisburg, PA)
- …members of the Medicare population and reports to the Lead Medical Director .** **Other duties:** + Identify medical management operational improvements, ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Wellpath (Lemoyne, PA)
- …education, and point of care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review, case ... management , quality improvement, and related policy and practice initiatives within...and the appropriate utilization of medical services. The Medical Director of Utilization Management serves as a… more
- WellSpan Health (York, PA)
- …respected group who pride themselves in fulfilling their mission to provide excellent inpatient care. **Expectations of Medical Director include:** + Ability to ... Group's drive to ensure that care is of high quality and value and is integrated across the system....in south central Pennsylvania is seeking an Associate Medical Director to aid in leading the hospitalist program at… more
- Datavant (Harrisburg, PA)
- …of admissions for medical necessity and necessity of continued stay in the inpatient patient care setting and/or discharge to an alternative level of care. Using ... Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. Experience with clinical criteria resources and payor guidelines. **You… more
- Penn Medicine (Lancaster, PA)
- …health system. There is an opportunity to work in varied clinical settings ( inpatient and outpatient) that may be tailored to the candidate's interests. The ... excellent interpersonal and communication skills. Clinical responsibilities include expert management of physical and emotional symptoms related to serious illness… more