• Field Case Manager, Registered Nurse…

    CVS Health (Bensalem, PA)
    …preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members. - 2 years Case Management, discharge planning, and/or ... comprised of network management, clinical coverage, and policies. Community Care Case Manager's use a collaborative process of assessment, planning, facilitation,… more
    CVS Health (08/08/25)
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  • Case Management Manager - UPMC

    UPMC (Washington, PA)
    …care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization/ case management, discharge planning, Medicare , Medicaid, and ... The Manager oversees the day-to-day operations of the Case management department under the direction of the...the Director. The Manager is accountable for the following Case Management functions: training, auditing, systems support: Case more
    UPMC (07/11/25)
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  • Roaming Clinical Reimbursement Coordinator, RN

    Genesis Healthcare (PA)
    …standards of care. *Manage the overall process and tracking of all Medicare /Medicaid case -mix documents to assure appropriate reimbursement for services provided ... within the nursing center. *Conduct concurrent MDS reviews to assure achievement of maximum allowable RUG categories. *Integrate information from nursing, dietary, social services, restorative, rehabilitation, and physician services to ensure appropriate… more
    Genesis Healthcare (08/30/25)
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  • Behavioral Health Medical Director…

    Humana (Harrisburg, PA)
    …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population + Current and ongoing Board Certification in an… more
    Humana (08/09/25)
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  • RN Medicare Compliance Sr

    Sedgwick (Harrisburg, PA)
    …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, ... review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations. **ARE YOU AN IDEAL CANDIDATE?** We are looking for… more
    Sedgwick (08/29/25)
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  • Worklife Resource Consultant - Medicare

    CVS Health (Harrisburg, PA)
    …various life and work situations. + Appropriately documents member interactions and research/ case fulfillment in the system. + Works in an inbound and outbound ... + 1+ year(s) experience in social work, social services, or case management field. + Private, confidential workspace free from distractions.professional,… more
    CVS Health (07/29/25)
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  • Medical Director - Medicare Appeals

    CVS Health (Harrisburg, PA)
    …Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business ... and clinical liaison to network providers and facilities if needed, to support the effective execution of medical services programs by the clinical teams. **Required Qualifications** *Two (2) or more years of experience in Health Care Delivery System eg,… more
    CVS Health (08/08/25)
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  • Medical Director -Pharmacy Appeals

    Humana (Harrisburg, PA)
    …complex to complex issues where the analysis of situations or data requires a case -by- case consideration of the Medicare rules, Humana policies and medical ... Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical...to support optimal value based care in accordance with Medicare and Humana policy. The Medical Director will collaborate… more
    Humana (08/22/25)
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  • Case Manager

    Sevita (Erie, PA)
    …specialized services for infants, children, adolescents, Military Service Members and Veterans. ** Case Manager - full time** **Monday thru Friday (on call weekends ... 5 other people!)** **Some travel required; meetings nearby and traveling to homes the Case manager supervises** The Case Manager meets and works with individuals… more
    Sevita (08/19/25)
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  • Registered Nurse - Case Manager

    WellSpan Health (Ephrata, PA)
    …1630 **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to ... discharge needs. Provides leadership in the integration of utilization and case management principles. **Duties and Responsibilities** + Reviews assigned patients… more
    WellSpan Health (08/24/25)
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