- 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
- Highmark Health (Monroeville, PA)
- …advisor and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization ... as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer...**Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association -… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... at our Lancaster, PA branch location.** The **RN Clinical Manager ** coordinates and oversees all direct care patient services...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- WM (Philadelphia, PA)
- …. Responsible for delivering excellence in cost, equipment availability, asset utilization , shop productivity management and performance improvements and fleet ... equipment is available to meet disposal operation requirements. Manage effective utilization of heavy equipment assets. Implement cost reduction, customer and… more
- ChenMed (Philadelphia, PA)
- …years' clinical work experience required + A minimum of one (1) year of utilization review and/or case management , home health, hospital discharge planning ... working remote for the remaining hours. The Acute Care Manager , Complex Care (RN) is responsible for achieving positive...patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with… 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...career with impact. Join us as an RN Case Manager in Care Coordination to strengthen that impact. Apply… more
- Highmark Health (Harrisburg, PA)
- …managing or supervising clinicians (such as pharmacists, nurses, or other clinicians) in a utilization management operations setting in a PBM or Health Plan. + ... + Pharmacy **EXPERIENCE** **Required** + 3 years of clinical pharmacy management experience including drug use review activities, operational oversight… more
- Burns & McDonnell (Conshohocken, PA)
- …, Program Manager as well as internal and external executive management as required. + Collaborate with engineering team to establish the development and ... **Description** The Construction Project Manager supports the Engineer Procure Construct (EPC) Project Manager or Program Manager to oversee day-to-day… 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. ... _Penn Medicine Lancaster General Health is recruiting for a full-time inpatient Case Manager to join a team of dedicated Case Managers managing a variety complex… more
- UPMC (Pittsburgh, PA)
- …with a Pennsylvania RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and ... 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