- UPMC (Pittsburgh, PA)
- …to candidates with a Pennsylvania RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services ... Health Plan is hiring a flex full-time UM Care Manager to support our UM Clinical Operations team. This...appropriate setting and cost - effective manner. **Responsibilities:** + Review and document clinical information from health care providers… 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) ... Experience: * And 5+ years Prior experience as a nurse case manager with knowledge of utilization review and third-party payors. We believe that the best… more
- AmeriHealth Caritas (Philadelphia, PA)
- …provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
- CenterWell (Harrisburg, PA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Harrisburg, PA)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… 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 ... recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with… more
- CDR Maguire (Allentown, PA)
- …As overseen by the PA Director of Construction Services and Construction Services Manager - PA East, provide Construction Management Support for PennDOT and PA ... as overseen by the PA Director of Construction Services and Construction Services Manager - PA East: + Promote excellent internal and external client service… more
- UPMC (Pittsburgh, PA)
- …you are caring for? UPMC Health Plan is hiring a full-time Clinical Care Manager to support our partnership with various physician practices. This role will support ... the Aiken Ave Employee Garage. As a Clinical Care Manager , you will be responsible for care coordination and...lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care… 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
- Commonwealth of Pennsylvania (PA)
- Assistant District Forester (Forest Assistant Manager ) - Clear Creek Forest District Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5009219) ... Apply Assistant District Forester (Forest Assistant Manager ) - Clear Creek Forest District Salary $67,736.00 - $102,905.00 Annually Location Multi-County, PA Job… more