- 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
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …Experience in Care Coordination, Discharge Planning, Clinical Documentation and Utilization Review preferred. Strong verbal, written and leadership skills. ... $6000 SIGN ON BONUS The role of the ER Care Manager is to increase patient through...and adjust to different environments. Knowledge of Interqual and utilization review standards. Experience in clinical documentation… 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