- 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 services… 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 ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
- Penn Medicine (Philadelphia, PA)
- …their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, ... hospice, community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management … more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director, Utilization Management provides organizational leadership in the operational areas of care management , ... policy and practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The… more
- CenterWell (Harrisburg, PA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Harrisburg, PA)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- 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 ... **Overview** **Critical Illness Recovery Hospital** **Case Manager (PRN)** _Requires a current licensure in a...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- Select Medical (York, PA)
- …by doing what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan management ... **Overview** **Critical Illness Recovery Hospital** **Case Manager ** **$5000 Sign On Bonus** _Requires a current...the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates… more
- UPMC (Pittsburgh, PA)
- …PA. Preference will be given to candidates with a Pennsylvania RN license. The Utilization Management (UM) Care Manager is responsible for utilization ... Health Plan is hiring a flex full-time UM Care Manager to support our UM Clinical Operations team. This...needed. Coordinates with Health Plan case managers or health management staff members to follow-up after discharge from an… more
- WellSpan Health (Lebanon, PA)
- …**Duties and Responsibilities** + 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... of resources to the attention of the appropriate manager (s). **Common Expectations:** + Demonstrates a commitment to patient,… more