- Highmark Health (Monroeville, PA)
- …also building relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care ... from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party guidelines. Obtains… more
- Baylor Scott & White Health (Harrisburg, PA)
- …least (3) three years of professional experience is required. + You must hold a valid Registered Nurse License ( RN ). As a health care system committed to ... based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for medical necessity and establish service… more
- UPMC (Tobyhanna, PA)
- …OR Licensed Professional Counselor (LPC) OR Licensed Social Worker (LSW) OR Psychologist OR Registered Nurse ( RN ) *Current licensure either in the state ... Behavioral Health is hiring a full-time Licensed Professional Care Manager for the Northeast PA region. The office is...the office as needed. The ideal candidate will have prior experience working with children, adolescents and IBHS. A… more
- UPMC (Pittsburgh, PA)
- …and Center for Emergency Medicine is hiring a full-time Licensed Professional Care Manager . This role will work standard daylight hours Monday - Friday. This ... County, however, when not travelling staff may work remotely. The Care Manager is responsible for assisting members identified at risk for recidivism, discontinuous… more
- Penn Medicine (King Of Prussia, PA)
- …with Penn Home Infusion Therapy policies and own level of responsibility.Provides the Nurse Manager with information about potential and/or actual problems and ... advance and provides notice to appropriate individuals. If required, prior authorization is obtained before scheduling applicable...clinical judgment to prepare accurate supply tickets. Credentials: + Registered Nurse - PA (Required) + PA,… more
- WellSpan Health (York, PA)
- …+ Rehabilitation Therapy, Nursing, or Respiratory Therapy experience. Required **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered ... those patients recommended for admission. Ensures that this approval is always obtained prior to patient admission to the WSRH. + Recommends other care options, as… more
- UPMC (Pittsburgh, PA)
- …within 30 days of hire + Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Registered Nurse ( RN ) + Act 33 with renewal + Act 34 with ... orientation. **Position Specifics:** Employee with be assisting providers with obtaining prior authorization for treatment and completing required documentation… more
- UPMC (Pittsburgh, PA)
- …specific tasks. . Prior experience with insurance verification and prior authorization for OP surgical procedures preferred. **Licensure, Certifications, and ... individual experience and education._ **Responsibilities:** + Work directly with Manager to identify opportunities for improvement with regards to… more