- UPMC (Pittsburgh, PA)
- …with a Pennsylvania RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and ... UPMC Health Plan is hiring a flex full-time UM Care Manager to support our UM Clinical...appropriate setting and cost - effective manner. **Responsibilities:** + Review and document clinical information from health care… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Utilization Management provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement ... and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
- CenterWell (Harrisburg, PA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional… more
- CenterWell (Harrisburg, PA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience +… more
- Guthrie (Sayre, PA)
- …five (5) years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management ... for alternate levels of care . The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration… more
- UPMC (Pittsburgh, PA)
- …healthcare resource utilization , case management interventions. Update the plan of care following review and communicate recommendations to the member and ... for? UPMC Health Plan is hiring a full-time Clinical Care Manager to support our partnership with... provider that promotes healthy lifestyles, closes gaps in care , and reduces unnecessary ER utilization and… more
- Highmark Health (Harrisburg, PA)
- …and interdisciplinary team partners including but not limited to: appropriateness of care , documentation requirements, utilization review principles and ... OVERVIEW:** This job has responsibility for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum.… more
- ChenMed (Philadelphia, PA)
- …assigned hospital daily from 9am-3pm, working remote for the remaining hours. The Acute Care Manager , Complex Care (RN) is responsible for achieving positive ... Management/Disease Management program with verbal introduction to their Community Care Manager for home visit once discharge...patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with… more
- Geisinger (Wilkes-Barre, PA)
- …to build a rewarding, lasting career with impact. Join us as an RN Case Manager in Care Coordination to strengthen that impact. Apply to learn more, we ... Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for...to hearing from you! Job Duties The RN Case Manager assesses, plans, implements, coordinates, monitors and evaluates all… more
- Aveanna Healthcare (Pittsburgh, PA)
- Care Experience Manager ApplyRefer a FriendBack Job Details Requisition #: 206751 Location: Pittsburgh, PA 15233 Category: Administrative/Clerical Salary: ... health and wellbeing of children and their families. The Care Experience Manager (CEM) is accountable for...clinician, and within insurance authorization. - Responsible to manage utilization of direct care team members based… more