• Case Manager

    PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
    … process is preferred. + Experience in a combination of home care management , case management review , utilization review , social service support, ... workplace, benefits administrators and individuals from other areas. The Case Manager facilitates the case management...other areas. The Case Manager facilitates the case management process along the healthcare continuum;… more
    PSKW LLC dba ConnectiveRx LLC (08/07/25)
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  • Dir, Care Coord - System Care Management

    Guthrie (Sayre, PA)
    management of all operational aspects for Care Coordination including, but not limited to Case Management , Utilization Review (UR), Utilization ... in and experience of payer contract language, as it relates to utilization management . Can navigate through the requirements imposed by all payers. Prior… more
    Guthrie (07/14/25)
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  • Director Utilization Mgmt (Do Or MD…

    Wellpath (Lemoyne, PA)
    …The Medical Director of Utilization Management leads and oversees utilization review , case management , quality improvement, and related ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders,… more
    Wellpath (08/08/25)
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  • Clinical Reimbursement Case

    Genesis Healthcare (York, PA)
    …2. Five to seven years of clinical nursing experience is required. Prior experience in utilization review , case management or discharge planning is ... a meaningful impact in the communities we serve. Responsibilities The Manager, Case Management is responsible for the clinical, administrative, and financial… more
    Genesis Healthcare (07/01/25)
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  • Medical Review Coordinator

    Prime Healthcare (Bristol, PA)
    …status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use ... institution in a Health and Human Services field is highly preferred. 2. Utilization Review / Case Management experience is highly preferred. 3. 1+ year… more
    Prime Healthcare (07/25/25)
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  • RN Acute Case Manager - System Care…

    Guthrie (Sayre, PA)
    …in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management certification or obtaining a ... and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in… more
    Guthrie (07/17/25)
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  • Registered Nurse (RN)- Case

    LifePoint Health (Johnstown, PA)
    …plays an important role in the care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff, and Discharge Planners ... and develop an individualized plan of care for our patients. The Case Management staff coordinates with the interdisciplinary team and community resources to… more
    LifePoint Health (08/09/25)
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  • Case Manager - RN - St Vincent Primary Care…

    Highmark Health (Harrisburg, PA)
    …health continuum. Incumbents will utilize nationally recognized standards of practice for case management by collaborating with providers, clinical teams, health ... including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and… more
    Highmark Health (07/28/25)
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  • Case Manager - UM II -100%

    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 efficient utilization of health… more
    Healthfirst (08/08/25)
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  • RN, Case Manager (Part time), Forbes

    Highmark Health (Monroeville, PA)
    …advisor and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization ... etc. Serves as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to… more
    Highmark Health (05/13/25)
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