- Perform prospective, concurrent, or retrospective utilization review/medical management for all services
- Evaluate the appropriateness of care based on contract, state, or URAC requirements
- Analyze and evaluate documentation submitted by program service providers
- Conduct reviews in the central office, on-site, or via teleconference for services requiring prior authorization
- Enter medical information into system(s)
- Participate in the Quality Improvement Program to continuously improve processes and performance
- Active Pennsylvania Nursing License
- Documented five years' plus experience in utilization review
- Knowledge of ICD-9 CM coding
- Functional knowledge of Microsoft Office
- Proficient writing and verbal communication skills
- Knowledge of utilization review processes
-
Charge Review Specialist, Physician Billing
2 weeks ago
St. Luke's Hospital Allentown, United States· St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to exce ...
-
Charge Review Specialist, Physician Billing
6 days ago
St. Luke's Hospital Allentown, United StatesSt. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excelle ...
-
St Luke's University Health Network Allentown, United States Full timeSt. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excelle ...
-
St. Luke's University Health Network Allentown, United States Full timeSt. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excelle ...
-
Practice Prior Authorization and Referral
6 days ago
St. Luke's University Health Network Allentown, United StatesSt. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission_ of our organization which is an unwavering commitment to excell ...
-
Accounts Receivable Specialist, Hospital Billing
2 weeks ago
St. Luke's University Health Network Allentown, United StatesSt. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission_ of our organization which is an unwavering commitment to excell ...
-
Supervisor Registration
1 week ago
Lehigh Valley Health Network Allentown, United States**Join a team that delivers excellence.** · Lehigh Valley Health Network (LVHN) is home to nearly 23,000 colleagues who make up our talented, vibrant and diverse workforce. · Join our team and experience firsthand what it's like to be part of a health care organization that's nat ...
-
Transitional Care Facility Admissions Specialist
2 weeks ago
St. Luke's University Health Network Allentown, United StatesSt. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission_ of our organization which is an unwavering commitment to excell ...
-
Billing Analyst
3 weeks ago
Lehigh Valley Health Network Allentown, United States**Join a team that delivers excellence.** · Lehigh Valley Health Network (LVHN) is home to nearly 23,000 colleagues who make up our talented, vibrant and diverse workforce. · Join our team and experience firsthand what it's like to be part of a health care organization that's nat ...
-
Director, Allentown School District
3 weeks ago
Da Vinci Science Center Allentown, United StatesThe Da Vinci Director of ASD Partnership will serve as the co-leader of a new and innovative partnership between ASD and the Da Vinci Science Center providing ASD students with consistent access to state-of-the-art experiences in Science, Technology, Reading, Engineering, Arts, a ...
-
Lpn - Emt
1 week ago
Biomat USA Inc Allentown, United StatesWould you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global healthcare company that since 1909 has been working to improve the health and well-being of people around the worl ...
-
Occupancy Specialist
3 weeks ago
OAHS Bethlehem Townhomes II Bethlehem, United States**Full time Compliance Occupancy Specialist LIHTC & HUD** · **RESPONSIBILITIES** · **JOB DESCRIPTION** · Daily responsibilities: · - Process initial, annual and interim recertification's, in addition to retroactive rent-calculations while conforming to HUD regulations and Low-Inc ...
-
HR Operations Coordinator
6 days ago
Smith College Northampton, United States. · Human Resources · **Job Description**: · HR Operations Specialist · Smith College has an opening for a seasoned HR Operations Specialist in the Human Resources department. · Do you want to be part of a team that values you? Join our dynamic team of skilled HR professionals wh ...
-
Accounts Specialist
2 weeks ago
Moravian University Bethlehem, United States**SUPERVISION RECEIVED**: Works under the direction of Director of Student Accounts. · **SUPERVISION EXERCISED**: N/A. · ***:The Accounts Specialist and Cashier will support the Office of Student Accounts with all phases of the maintenance of student accounts. These functions can ...
-
Recreation Specialist I for Autism Center
2 weeks ago
Pathlight Group Northampton, United States**_Join us at Pathlight Group's Autism Center as a full-time Recreations Specialist to Create & Plan Recreation and Social opportunities for families and individuals to connect with each other and the communities they live in by creating, planning, updating and coordinating event ...
-
Medical Records Coordinator
1 day ago
SeniorLIFE of PA Bethlehem, United States**Medical Records Clerk** · **Full Time · - Monday-Friday 8AM - 4:30PM** · **Bethlehem, PA** · Senior LIFE is an innovative home and community based Medicare and Medicaid funded program which provides all-inclusive healthcare services and support to seniors living in the communit ...
-
Recruiting & Onboarding Specialist
3 days ago
Moravian University Bethlehem, United States**SUPERVISION RECEIVED**: Works under the direction of the Associate Director of Human Resources. · **SUPERVISION EXERCISED**: Student workers as appropriate. · ***:The Recruiting & Onboarding Specialist manages the coordination and control of recruiting & onboarding processes in ...
-
Arc Admissions Specialist
4 days ago
St. Luke's University Health Network Bethlehem, United StatesSt. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission_ of our organization which is an unwavering commitment to excell ...
-
Compensation and Benefits Specialist
5 days ago
CLIU #21 Schnecksville, United States**Position Definition**:The **Compensation and Benefits Specialist** is responsible for coordinating, developing, and implementing employee benefits and compensation. This position will work closely with leaves and workers compensation processing. · **Relationship**:The **Compens ...
-
Assistant Site Manager
6 days ago
CO-MHAR INC Walnutport, United StatesAssistant Site ManagerJob Details · Job Type · Full-time · Walnutport, PA - CRRSDescription · **Position**:Assistant Site Manager · **Location**: Walnutport, PA · **Job Type**: Full Time (32 Hours); Non-exempt · **Compensation**: Starts at $17.00 per hour · **Schedule**:8:00AM- 1 ...
Clinical Review Specialist - Allentown, United States - The CKHobbie Group
Description
This is a remote position.
The Clinical Review Specialist will be responsible for performing prospective, concurrent, or retrospective utilization review/medical management for all services provided by our organization. This role entails evaluating the appropriateness of care based on contract, state, or URAC requirements. They will also analyze and evaluate documentation submitted by program service providers and conduct reviews either in the central office, on-site, or via teleconference for services requiring prior authorization. Additionally, the incumbent will enter medical information into system(s), participate in the Quality Improvement Program to continuously enhance processes and performance, and must maintain an active Pennsylvania Nursing License.Key Responsibilities: