- UPMC (Pittsburgh, PA)
- The Care Manager Associate (CMA) position will be part of the UPMC Health Plan's Community Services Community Paramedic Team. The team expands paramedic roles ... the CMA's collaborations, practical comprehension and hands-on experience in clinical care / utilization management will result by collecting and assisting with… more
- UPMC (Mechanicsburg, PA)
- …required.KNOWLEDGE AND SKILLS:Expertise in care management, discharge planning and utilization review processes. Ability to build credible and effective ... The Manager oversees the day-to-day operations of the Clinical Care Coordination and Discharge Planning Department under the direction of the Director. The … more
- Penn Medicine (Philadelphia, PA)
- …+ Registered Nurse - PA (Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) ... care , achieve clinically appropriate and financially sound resource utilization , support the insurance verification team, clinical staff and...And 5+ years Prior experience as a nurse case manager with knowledge of utilization review… more
- Veterans Affairs, Veterans Health Administration (Butler, PA)
- …and critical thinking skills. Possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, ... Medical Center within our Community Care Section as an RN Care Manager . Community Care at the VA provides care to Veterans through community… more
- LifePoint Health (Johnstown, PA)
- …seeking a full-time Practice Manager for the CPG East Hills Primary Care and Medwell. The primary responsibilities of the Practice Manager include ... federal, state or local law./ **Job:** **Administration/Management* **Organization:** ** **Title:** *Practice Manager - CPG East Hills Primary Care & Medwell*… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... at our Lancaster, PA branch location.** The **RN Clinical Manager ** coordinates and oversees all direct care ...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Highmark Health (Monroeville, PA)
- …party payers. + Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract ... etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to… more
- Healthfirst (PA)
- The Case Manager , Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge ... planning, and case management as assigned. The Case Manager , Utilization Management is also responsible for...care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of… more
- Genesis Healthcare (York, PA)
- …to seven years of clinical nursing experience is required. Prior experience in utilization review , case management or discharge planning is required. Prior ... we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care … more
- Penn Medicine (Lancaster, PA)
- …the Pennsylvania Board of Nursing. + Bachelor's degree in Nursing BSN . + Knowledge of utilization review or managed care . + Care management experience ... episode of care to encompass coordination of care across the continuum. The Case Manager ...across the continuum inpatient outpatient community to assure appropriate utilization of clinical and community resources. + Oversees and… more