- UPMC (Murrysville, PA)
- …OR Cardiopulmonary Resuscitation (CPR) + Certified Case Manager (CCM) + Driver's License + Registered Nurse ( RN ) + Act 33 with renewal + Act 34 with ... 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… more
- UPMC (Pittsburgh, PA)
- …OR Cardiopulmonary Resuscitation (CPR) + Certified Case Manager (CCM) + Driver's License + Registered Nurse ( RN ) + Act 33 with renewal + Act 34 with ... UPMC Health Plan is hiring a full-time Clinical Care Manager to work onsite at General Academic Pediatric office...lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care… more
- 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 ... Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory… more
- WellSpan Health (Lewisburg, PA)
- …practice experience. Required + Lean Daily Management experience. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered ... practice and across transitions of care. + Responsible for hiring, performance review of Clinical Supervisors. + Collaborates with Practice Managers to provide… more
- CenterWell (Harrisburg, PA)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing 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 focuses on excellent… more
- Highmark Health (Pittsburgh, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions,… more
- Amergis (Pittsburgh, PA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... The RN Case Manager is responsible for...of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical… more
- UPMC (Pittsburgh, PA)
- …overall responsibility for all aspects of contract management including quality assurance, utilization review , ROI and other areas as appropriate + Bachelor's ... Hillman Cancer Center is currently hiring a Regional Operations Manager , ONC ( RN ) to support their world...support their world class Medial Oncology/Infusion community network. This nurse leader will be responsible for various Hillman Cancer… more
- Deloitte (Philadelphia, PA)
- …as clinical registered nurse , physician, physician assistant, case manager , clinical documentation specialist, utilization review , informatics RN ... in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical Documentation Specialist… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. + Adheres to the policies, procedures, rules,… more