- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... excelling in this position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- UPMC (Pittsburgh, PA)
- **UPMC In-Home Services is looking for a Nurse Clinical Coordinator to support their UPMC Your Care team in the Monroeville area. This is a Monday through Friday ... position with daylight hours.** **Purpose:** The Nurse Clinical Care Coordinator is responsible for the delivery of nursing assessment and evaluation within… more
- Fresenius Medical Center (Baden, PA)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- UPMC (Pittsburgh, PA)
- Are you an experienced nurse with an extensive background in case management? Are you looking for an opportunity to use your nursing assessment skills without ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
- UPMC (Blawnox, PA)
- …promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, ... and other health plan and system departments as appropriate. + Review member's current medication profile; identify issues related to medication adherence,… more
- Highmark Health (Jefferson Hills, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions,… more
- UPMC (Pittsburgh, PA)
- …hiring a full-time Supervisor Physician Assistant or Acute Care Certified Registered Nurse Practitioner to support the Neurosurgery department at UPMC Mercy. This ... between inpatient and outpatient services, optimizing patient care and resource utilization . + Participate in the recruitment, onboarding, and training of new… more
- STG International (Rochester, PA)
- …safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. + Provide leadership to CBOC clinicians. + Evaluate the… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. + Adheres to the policies, procedures, rules,… more
- UPMC (Pittsburgh, PA)
- …+ Knowledge of computer technology, quality assurance activities, DRG, Quality Insights/ Utilization review background is highly preferred. + Ability to ... Certifications, and Clearances:** + Certified Coding Specialist (CCS) OR Certified Registered Nurse Practitioner OR Doctor of Medicine (MD) OR Doctor of Podiatric… more
- Highmark Health (Pittsburgh, PA)
- …+ Performs as the clinical subject matter expert for clinical, quality, care, utilization , high cost claim and population health management as the part of the ... and accounts after customer discussions.Participate in ad-hoc and annual clinical review meetings as needed to provide clinical, health and wellness perspective;… more