- Penn Medicine (Philadelphia, PA)
- …+ 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + Pennsylvania State Licensed Nurse ... And 5+ years Prior experience as a nurse case manager with knowledge of utilization review and third-party payors. We believe that the best care for our… more
- Penn Medicine (Lancaster, PA)
- …of Nursing. + Bachelor's degree in Nursing BSN . + Knowledge of utilization review or managed care. + Care management experience in a managed care setting. ... across the continuum inpatient outpatient community to assure appropriate utilization of clinical and community resources. + Oversees and...+ Helps in identification of best methods to transmit case management plan to all points of… more
- CVS Health (Harrisburg, PA)
- …within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers ... overcome barriers to meeting goals and objectives. + Utilizes case management processes in compliance with regulatory...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Geisinger (Wilkes-Barre, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for...and healthcare team. + Maintains required documentation for all case management activities. + Collects required data… more
- Highmark Health (Pittsburgh, PA)
- …**Job Description :** Date Posted: 20250509 Location: Allegheny General Hospital Department: Case Management , Inpatient Status: Full Time Shift: 80 hours every ... hours per week, rotating weekends and holidays Union: Yes ** CASE MANAGEMENT :** The Case ...operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination… more
- LifePoint Health (Johnstown, PA)
- … management program.Ensure staff competencies in all areas of care management to include utilization review , transition/discharge planning, social work ... Development and Growth Opportunities . And much more Position Summary: Provide Case Management leadership and management for hospitals within a market of… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... community resourcesParticipates and drives accountability in daily interdisciplinary meetings Utilization Management :Adheres to guidelines to satisfy 3rd party… more
- BriteLife Recovery (Hanover, PA)
- …healthcare providers, community resources, and family members. + Documenting all case management service notes, assessments, reassessments, referrals and ... CASE MANAGER Do you work for a company...+ Under direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review … more
- CVS Health (Harrisburg, PA)
- …Qualifications** + Crisis intervention skills preferred + Managed care/ utilization review experience preferred + Case management and discharge ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of… more
- St. Luke's University Health Network (Easton, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... with mental health illness. Previous experience in discharge planning and case management models preferred.Current Behavioral Health department program for… more