- R1 RCM (Pittsburgh, PA)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. **Title: Utilization Review Author** **Location: Hospital Client located in ... vary and some flexibility may be offered** As our ** Utilization Review Author** , you will help...opportunities that promote growth. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- UPMC (Pittsburgh, PA)
- UPMC Your Care is hiring Nurse (RN) Clinical Care Coordinator. Your territory will be in the various locations for Pittsburgh and Monroeville areas. You will be ... The office is located at Harbor Gardens, 1650 Metropolitan Street, 15233. The Nurse Clinical Care Coordinator is responsible for delivery of nursing assessment and… more
- UPMC (Pittsburgh, PA)
- …criteria (InterQual). + Ability to apply InterQual criteria appropriately. + Prior utilization review experience. + Knowledge of payer reimbursement structure. + ... career? UPMC is looking to hire a full-time Authorization Nurse . This position works Monday through Friday, as well...level of care and/or medical appropriateness. + Ensure clinical review process is followed in order to meet payor… more
- UPMC (Pittsburgh, PA)
- **UPMC Your Care is hiring a Triage Nurse . You will be working Monday-Friday daylight hours Rotating call coverage throughout the week and rotating every 3-4 ... Care interdisciplinary team, which allows for ultimate clinical decision-making by the nurse . Assess the actual caller to determine the caller's understanding of the… more
- Highmark Health (Jefferson Hills, PA)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to… more
- UPMC (West Mifflin, 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
- UPMC (Pittsburgh, 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)
- …related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization . This includes using vast clinical knowledge to ensure correct ... but are not limited to analysis of payment policies, prepayment, and post payment review of high dollar claims, and prepayment review of diagnosis and procedural… more
- UPMC (Mckeesport, PA)
- …required. + Knowledge and Skills: Expertise in care management, discharge planning and utilization review processes. + Ability to build credible and effective ... Worker (LSW) OR Other Healthcare Professional Licenses for Discharge Planning OR Registered Nurse (RN) + Act 33 with renewal + Act 34 *Current licensure either… more
- UPMC (Pittsburgh, PA)
- …the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals ... all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria...and Clearances:** + Current licensure as a Registered Professional Nurse either in the state where the facility is… more