- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview:** The Medical Director, Utilization Management , provides organizational leadership in the operational areas of appeals, utilization review, ... policy and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical Affairs. ; **Work… more
- Guthrie (Sayre, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... Bonus For Qualified RNs! Position Summary: The Acute Case Manager utilizes industry accepted processes for achieving optimal patient,...experience in an acute care setting with strong care management , utilization review, and payer knowledge… more
- WellSpan Health (Mount Gretna, PA)
- …principles. **Essential Functions:** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and...Life Support Upon Hire Required + Certified in Case Management Preferred ** Knowledge , Skills, and Abilities:** +… more
- Magellan Health Services (Somerset, PA)
- …health care setting.* Strong organization, time management and communication skills.* Knowledge of utilization management procedures, mental health and ... an active work load in accordance with National Care Manager performance standards. + Works with community agencies as...Strong organization, time management and communication skills. Knowledge of utilization management procedures,… more
- St. Luke's University Health Network (Allentown, PA)
- …patient's ability to pay for health care. The IT Vendor and Contracts Manager leads IT's Vendor/Contact Management Office (VCMO). Responsibilities include but ... and attainment, reporting and governance. At an operational level, the Manager directs contract consultations and negotiations, including contract reviews, analysis,… more
- UPMC (Washington, PA)
- The Manager oversees the day-to-day operations of the Case management department under the direction of the Director. The Manager is accountable for the ... care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization /case management , discharge planning, Medicare, Medicaid, and… 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) ... not limited to admissions, patient financial services, clinical resource management and provider medical staff and designees.Assist in preparation...And 5+ years Prior experience as a nurse case manager with knowledge of utilization … more
- Magellan Health Services (Bethlehem, PA)
- …Provides support to Care Managers and other clinical team members through content knowledge , technical and utilization management expertise. Researches open ... License (BSL) in the state of Pennsylvania is required. Knowledge of DSM V or most current diagnostic edition...unresolved issues for Care Managers who are providing direct utilization management services. Mentors new Care Managers… more
- Highmark Health (Erie, PA)
- …effective resource utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization , and patient/family ... or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case … more
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