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Offer office education during the entire access process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
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Attends inter-departmental meetings alongside QM manager and Director; updates processes and/or workflow activities to departments such as Utilization Management and Complaints and Grievances, and Credentialing Committee.
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The Ideal Candidate: Pennsylvania Licensed Certified Registered Nurse Practitioner (CRNP)At least 2+ years of experience as an NPExperience within Community Health, Infectious Disease, Primary Care, or Internal MedicineDetailed knowledge of care transitions, strategies for reducing readmissions, and chronic condition management interventionsExperience with Medicare, Medicaid, and commercial populationsExcellent organizational and communication skillsACLS certification.
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Point of call contact for brokers, plan sponsors, trustees, participants, mutual fund contacts BCG CMS Call Center utilization and management. This position is responsible for account management services resulting in contributions to enhanced service delivery, plan retention and new plan and advisor acquisition with the intent to shift client and advisor perception of BCG from service provider to value-add partner.
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Provide leadership in the design, implementation and utilization of the Human Capital Management (HCM) system to ensure process efficiency and data integrity. As a member of the Executive Leadership Team, this position is responsible for all aspects of management and planning for Human Resources; Diversity, Equity, Inclusion and Belonging (DEIB); and Training & Development departments to assist CORA Services in achieving its strategic goals and optimizing its operations.
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5+ years of project management in a design studio, internal creative department, or agency environment with demonstrated success managing broad range of multimedia communications in a fast-paced environment.
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As the Quality Management Coordinator II, your daily duties may include: Perform investigations of potential quality of care concerns referred to the QM Department from multiple internal resources and external sources such as but not limited to: UM, Care Management, Complaints and Grievances and Provider Tip Line. Perform quality of care reviews on cases identified as Preventable Serious Adverse Events, based on the CMS / DPW Bulletin.
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This experience typically includes: monitoring occupant space utilization, energy and water conservation, sustainability and environmental hazards programs; coordinating alteration and renovation projects; gathering information to assess the level of customer satisfaction, i.e., surveys, interviews with tenant contacts, focus groups; monitoring real property budgetary and financial data; and, administration of repair and/or operation and maintenance contracts.
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Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment. Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
Full-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Follow established PCC workflow for utilization and self-management support. Provides telephonic and or in-practice outreach, disease management and/or case management, education, and other clinically based activities for target populations.
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Provide outreach, care management and education for disease self-management per patient centered goals. 5 years or more clinical experience, Experience in primary care, population or case management preferred.
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The Case Manager performs ongoing PI/QA during concurrent review to identify quality of care issues, risk management issues, and performs blood/blood products and medication utilization.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Penn Presbyterian Medical Center (PPMC) has an outstanding opportunity for an Inventory Manager to join the Materials Management team and work alongside some of the best medical providers in Philadelphia.
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Supports and ensures timely input, proper use and full utilization of on-site PC-based property management software for leasing data. Incredible associate rental discount if you choose to live on-site.
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Build profitable business and script growth through recommended clinical programs including appropriate immunization and when available MTM (Medication Therapy Management), DCS (Diabetes Care Specialist), and all ongoing other programs as identified.
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utilization management jobs in Philadelphia, PA
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