• Case Management Manager - UPMC

    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
    UPMC (07/11/25)
    - Related Jobs

  • RN Pre Certification Case Manager

    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
    Penn Medicine (08/07/25)
    - Related Jobs

  • Lead Care Manager , Autism - PA (Remote,…

    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
    Magellan Health Services (08/13/25)
    - Related Jobs

  • Case Manager , RN - ED (Full Time), St.…

    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
    Highmark Health (09/11/25)
    - Related Jobs

  • Care Manager , BH - Remote in PA, Bedford

    Magellan Health Services (Somerset, PA)
    …health care setting. Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...an active work load in accordance with National Care Manager performance standards. + Works with community agencies as… more
    Magellan Health Services (07/24/25)
    - Related Jobs

  • Clinical Care Manager (RN) - Erie

    UPMC (Pittsburgh, PA)
    …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... to enhance their knowledge and skills related to health or lifestyle management . + Contact members with gaps in preventive health care services and assist them… more
    UPMC (09/10/25)
    - Related Jobs

  • Case Manager / PRN ( RN / RT / SW / LPN )

    Select Medical (Mckeesport, PA)
    …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with… more
    Select Medical (10/01/25)
    - Related Jobs

  • Acute Care Manager (RN)

    ChenMed (Philadelphia, PA)
    …identifies functional status (ADLs and PT needs), discusses medications and self- management , identifies and corrects knowledge deficits. + Supports, collaborates ... + Performs other duties as assigned and modified at manager 's discretion. ** KNOWLEDGE , SKILLS AND ABILITIES:** +...required + A minimum of one (1) year of utilization review and/or case management , home health,… more
    ChenMed (07/25/25)
    - Related Jobs

  • RN Case Manager (Part Time) - West Penn…

    Highmark Health (Pittsburgh, PA)
    …party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization changes, contract ... or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association - American Case … more
    Highmark Health (09/13/25)
    - Related Jobs

  • Account Manager - Philadelphia, PA…

    J&J Family of Companies (Philadelphia, PA)
    …their journey to wellness. Learn more at https://www.jnj.com/medtech As a Field Sales Account Manager , this individual will serve as the point person for end to end ... development and clinical success, including procedure sales, support and driving utilization for all Auris Surgical Robotics Technologies. The Field Sales Account… more
    J&J Family of Companies (09/23/25)
    - Related Jobs