- Geisinger (Danville, PA)
- …teams assistance with nursing skill mix optimization. + Assist in review of ambulatory nursing position justifications to ensure appropriate scope assignment. ... staff and members of other departments, effective communications, appropriate resource utilization and sound planning skills. + Communicates pertinent information as… more
- Penn Medicine (Philadelphia, PA)
- …(Required) + 5yrs prior experience as a Nurse Case Manager with knowledge of utilization review and 3rd Party Payors (Required) + Pennsylvania State Licensed ... 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 patients… more
- CVS Health (Harrisburg, PA)
- …Counselor) **Preferred Qualifications** + Crisis intervention skills preferred + Managed care/ utilization review experience preferred + Case management and ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Assessment of… more
- Genesis Healthcare (Mechanicsburg, PA)
- …clinical utilization , and patient identification is overseen by a licensed therapist. 21. Performs other related duties as required. Qualifications 1. Graduate ... Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 7. Assists Clinical Operations Area Director in the hiring… more
- Guthrie (Troy, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration...or position and b) Demonstrated leadership skills for a licensed degree exception, there must be a significant depth… more
- WellSpan Health (York, PA)
- …individual staff to ensure safe quality care, progress towards goals, and proper utilization of services. * Provides after-hours and on-call staff support as well as ... and development of new clinical policies and the regular review and updating of existing clinical policies as indicated.*...Care in a professional manner. * Responsible for efficient utilization of all resources including, but not limited to,… more
- Humana (Harrisburg, PA)
- …for requested services using clinical judgment and refers to internal stakeholders for review depending on case findings. + Educates providers on utilization and ... guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse (RN) in the state of Virginia or obtain a… more
- St. Luke's University Health Network (Easton, PA)
- …appropriate to the age of the patient treated. + Performs admission review on all inpatients. Attends daily patient rounds and shares professional knowledge, ... appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of...EDUCATION: Master's degree in Social Work or Counseling EDUCATION: Licensed Social Worker, MSW, or Licensed Professional… more
- WellSpan Health (York, PA)
- …members, referral sources and external payers regarding the effective and efficient utilization of program service and available resources as well as the benefit ... and need for inpatient level rehabilitation services. Assessment includes chart review , clinical physical assessment and interaction with the physician, nurses and… more
- Genesis Healthcare (Sinking Spring, PA)
- …ensuring a smooth and well-prepared transition for new residents. *Lead the team review of all new patient admissions and readmissions for skin integrity needs, ... and goal setting. *Manage specialty support surfaces, ensuring appropriate utilization , collaborating on audits, and leading quality improvement initiatives related… more