Pittsburgh, Pennsylvania, United States · Hybrid
Company :Highmark Inc.Job Description : JOB SUMMARY *** This position is a Hybrid position, Tue/Wed/Thur in the office and Work from home on Mon/Fri **** This job captures all inbound inquires for utilization management …
Skills: Customer service, Data entry, Utilization management, Healthcare industry knowledge, Communication skills
Philadelphia, Pennsylvania, United States · Hybrid
$90k–$157k/yr
Career CategorySalesJob Description Territory covers: Pittsburgh N Relocation is not offered for this role. Join Amgen’s Mission of Serving Patients At Amgen, if you feel like you’re part of something bigger, it’s becaus…
Skills: Sales, Clinical knowledge, Marketing strategy, Account management, Relationship building
Pittsburgh, Pennsylvania, United States · Hybrid
$420k–$1100k/yr
Company :Allegheny Health NetworkJob Description : Allegheny Health Network (AHN) is building the future in its Department of Radiology and Imaging Sciences by adding several services and locations to their network. The …
Skills: Cardiothoracic imaging, Diagnostic radiology, Chest CT, Cardiac CT, Cardiac MRI
Pittsburgh, Pennsylvania, United States · Hybrid
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: `Serves as the consistent point of contact for referring physicians, patients, caregivers, families, and the community. Facilitates patient flow, inclu…
Skills: Nursing, Patient navigation, Care coordination, Patient education, Community outreach
Pittsburgh, Pennsylvania, United States · Hybrid
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: Acts as a consultant to service line leadership. Analyzes financial results, trends and performance metrics, prepares business plans including periodic…
Skills: Business Forecasting, Financial Analysis, Data Management, Compensation Modeling, Business Planning
Pittsburgh, Pennsylvania, United States · On-site
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: Completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serv…
Skills: Patient scheduling, Pre-registration, Insurance verification, Medical terminology, Authorization validation
Philadelphia, Pennsylvania, United States · Remote OK
$117k–$208k/yr
Job TitleEnterprise Service Program Manager (East Zone) Job Description As an individual contributor in this Enterprise Service Program Manager role, you will serve as the main corporate and customer/facility point of co…
Skills: Customer partnership management, Strategic governance, Service escalation management, Data analysis, Reporting
Pittsburgh, Pennsylvania, United States · On-site
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: This job is responsible for performing andrology/endocrinology procedures and providing technical oversight of the andrology and endocrinology lab. ESS…
Skills: Andrology, Endocrinology, Laboratory supervision, Specimen examination, Test analysis
Pittsburgh, Pennsylvania, United States · On-site
Now Hiring: Intake Specialist / QA Visits Emerest Health of PA | Pittsburgh, PA & Surrounding Areas This is not a remote position. Emerest Health of PA is seeking a dedicated and compassionate Intake Specialist to join o…
Skills: Intake assessment, Quality assurance, Home care, Healthcare documentation, Client assessment
Pittsburgh, Pennsylvania, United States · Hybrid
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: The Registered Nurse assesses human responses and plans, implements and evaluates nursing care for individuals or families for whom the nurse is respon…
Skills: Nursing care, Patient assessment, Clinical practice, Interdisciplinary collaboration, Patient safety
Dialysis Clinic, Inc.Pittsburgh, Pennsylvania, United States · On-site
$33/hr–$44/hr
Overview Registered Nurse (RN) - Acute Care Paid Dialysis Training | $8,000 Sign-On Bonus Dialysis Clinic, Inc. (DCI) is looking for a compassionate and motivated Registered Nurse (RN) to join our Hospital Services team …
Skills: Acute dialysis nursing, Patient assessment, Dialysis equipment operation, Medication administration, Clinical documentation
Pittsburgh, Pennsylvania, United States · On-site
$20/hr–$23/hr
You’ve invested a lot of time and energy in your education. Now you want the chance to make your mark. We offer challenging opportunities for you to learn and grow professionally. In our programs, you’ll be immersed in a…
Skills: Pharmacy operations, Prescription fulfillment, Patient counseling, Immunization administration, Customer service
Pittsburgh, Pennsylvania, United States · On-site
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: This position will provide continuous observation and surveillance of multiple patients across the AHN network requiring close observation via a centra…
Skills: Patient monitoring, Surveillance, Critical thinking, De-escalation techniques, Computer proficiency
Pittsburgh, Pennsylvania, United States · On-site
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: As a member of the health care team, the Medical Assistant Lead provides clinical oversight and provides guidance at large multi-site practices. Overse…
Skills: Clinical oversight, Staff training, Electronic health record, Patient care coordination, Medication reconciliation
Pittsburgh, Pennsylvania, United States · On-site
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW This job performs prescribed radiographic imaging procedures at a technical level not requiring constant supervision. Competently performs a variety of …
Skills: Radiographic imaging, Patient positioning, Image quality analysis, Contrast media administration, Medication administration
Pittsburgh, Pennsylvania, United States · Hybrid
$19/hr–$23/hr
CMS At ZOLL, we're passionate about improving patient outcomes and helping save lives. We provide innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related ser…
Skills: Technical support, Troubleshooting, Customer service, Communication, CRM systems
Pittsburgh, Pennsylvania, United States · On-site
State of Location: Pennsylvania Position Summary: Join Ivy Health’s dedicated pediatric team where you are not just an employee but a valued teammate! Together, we provide world-class care in physical therapy, occupation…
Skills: Physical therapy, Pediatric physical therapy, Early intervention, Coaching model, Patient care
Pittsburgh, Pennsylvania, United States · On-site
Work Schedule Standard (Mon-Fri) Environmental Conditions Office Job Description Job Description As part of the Thermo Fisher Scientific team, you’ll discover meaningful work that makes a positive impact on a global scal…
Skills: Product management, Strategic planning, P&L management, Product lifecycle management, Portfolio planning
Pittsburgh, Pennsylvania, United States · On-site
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: Responsible and accountable for a designated patient population for the purpose of providing care based upon enactment of the nursing process. ESSENTIA…
Skills: Clinical assessment, Care planning, Patient care delivery, Multidisciplinary collaboration, Patient education
Pittsburgh, Pennsylvania, United States · On-site
Company :Allegheny Health NetworkJob Description : GENERAL OVERVIEW: This job is an integral part of the care delivery system working together to provide a healing environment, by placing our customers first. The incumbe…
Skills: Inpatient care, Neurology, Patient assessment, Treatment planning, Diagnostic interpretation
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The incumbent captures inbound inquiries for utilization management, verifies member benefit coverage, and performs data entry to create cases for clinical review. They also conduct outreach to providers and pharmacists to gather necessary documentation and ensure regulatory compliance.
Candidates must have at least one year of customer service experience and one year of experience in the healthcare industry. A high school diploma or GED is required, along with proficiency in administrative systems and strong communication skills.
JOB SUMMARY
* This position is a Hybrid position, Tue/Wed/Thur in the office and Work from home on Mon/Fri **
This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax, Predictal Availity portal and/or service form inquiry. At times may require follow-up communication with the requestor's office (physicians or pharmacists). This role may be required to make outbound calls and/or triage cases if inventory levels require support.
ESSENTIAL RESPONSIBILITIES
EXPERIENCE
Required
SKILLS
EDUCATION
Required
LICENSES or CERTIFICATIONS
Required
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office- This position is a Hybrid, Tue/Wed/Thur in the office and Work from home on Mon/Fri
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
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Our mission is to create a remarkable health experience, freeing people to be their best.
Allegheny Health Network is an integrated health care delivery system serving the greater Western Pennsylvania region. More than 2,600 physicians and 21,000 employees serve the system's 16 hospitals as well as its ambulatory medical and surgery centers, Health + Wellness Pavilions, and hundreds of physician practice locations. AHN is a proud part of Highmark Health.
Offices: 4800 Friendship Ave, Pittsburgh, Pennsylvania 15224, US · 2570 Haymaker Rd, Monroeville, Pennsylvania 15146, US · 320 E North Ave, Pittsburgh, Pennsylvania 15212, US · 12351 Perry Hwy, Wexford, Pennsylvania 15090, US · 1301 Carlisle St, Natrona Heights, Pennsylvania 15065, US
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Companies currently hiring include UPMC, Allegheny Health Network, CVS Health, St. Peter's Health Partners, Net Health, among others. Browse the listings above to see every active employer.
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