• Utilization Management Nurse…

    CVS Health (Harrisburg, PA)
    …it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
    CVS Health (05/15/25)
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  • RN - Registered Nurse…

    Geisinger (Danville, PA)
    …and License(s) Basic Life Support Certification - Default Issuing Body; Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE & ... Job Summary Please note this is NOT a remote position. Geisinger is proud to offer an Virtual ICU RN a $41 minimum hiring rate with increased rates for… more
    Geisinger (05/10/25)
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  • Clinical Registered Nurse…

    Sharecare (Harrisburg, PA)
    …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… more
    Sharecare (05/10/25)
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  • Registered Nurse , Telehealth…

    ChenMed (Philadelphia, PA)
    …rapidly expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
    ChenMed (04/24/25)
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  • HEDIS Registered Nurse or LPNs…

    Insight Global (Philadelphia, PA)
    …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
    Insight Global (04/01/25)
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  • Utilization Management Clinician…

    CVS Health (Harrisburg, PA)
    …in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state ... EST. No weekends or holidays. - 1+ years of utilization review/ utilization management required -...preferred **Education** Master's Level Behavioral Health degree or if Registered Nurse , Associates degree required, BSN preferred.… more
    CVS Health (05/15/25)
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  • Denials Management Specialist ( RN…

    St. Luke's University Health Network (Allentown, PA)
    …hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial experience related ... regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and… more
    St. Luke's University Health Network (05/14/25)
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  • Transplant Care Nurse RN - Stem…

    Highmark Health (Harrisburg, PA)
    …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
    Highmark Health (04/25/25)
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  • Care Manager, BH - Remote

    Magellan Health Services (Newtown, PA)
    …- Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... with necessary degrees: CEAP, LMSW, LCSW, LSW, LPC or RN . Minimum 2 years experience post degree in healthcare,...time management and communication skills. Knowledge of utilization management procedures, mental health and substance… more
    Magellan Health Services (05/13/25)
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  • Registered Dietitian - Remote

    Sharecare (Harrisburg, PA)
    …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager....will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
    Sharecare (05/03/25)
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