• 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 Manager, Registered Nurse

    CVS Health (Harrisburg, PA)
    …preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members. - 2 years Case Management, discharge planning, and/or ... all with heart, each and every day. **Position Summary** Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care… 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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  • Clinical Reimbursement Coordinator, RN

    Genesis Healthcare (York, 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 (08/08/25)
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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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  • 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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  • Case Manager - UM II -100%

    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,...Interqual and/or Milliman knowledge + Knowledge of Centers for Medicare & Medicaid Services (CMS) or New York State… more
    Healthfirst (08/08/25)
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  • Registered Nurse - Case Manager - Day

    WellSpan Health (Lebanon, PA)
    …rotation **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 (07/22/25)
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  • Case Manager RN - York Hospital - Days

    WellSpan Health (York, PA)
    …**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. **Essential Functions:** + Reviews assigned patients for… more
    WellSpan Health (07/22/25)
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