• RN Clinical Manager

    CenterWell (Lancaster, PA)
    …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... **Branch Location** : Lancaster, PA **This is not a remote or work-from-home position. This position requires you to...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (09/19/25)
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  • Acute Care Manager ( RN )

    ChenMed (Philadelphia, PA)
    …RN with bachelor's degree in a related clinical field preferred + A valid, active Registered Nurse ( RN ) license in State of employment required + Compact ... on-site at an assigned hospital daily from 9am-3pm, working remote for the remaining hours. The Acute Care Manager,...required + A minimum of one (1) year of utilization review and/or case management , home health,… more
    ChenMed (07/25/25)
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  • RN Care Coordinator - Strategic Insurance…

    Guthrie (Towanda, PA)
    …data analysis and process outcome evaluation. Education, License & Cert: Licensed Registered Nurse . Bachelor's Degree in Nursing or related field required. ... applicant must have a current license as a Professional Registered Nurse in their state of practice...in nursing practice. Preferred experience with PCMH process, care management / utilization review, and payer knowledge. Fast paced… more
    Guthrie (08/12/25)
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  • Disease Management Nurse…

    Sharecare (Harrisburg, PA)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
    Sharecare (09/13/25)
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  • Care Manager, BH - Remote in PA, Bedford

    Magellan Health Services (Somerset, PA)
    …Counselor - Care MgmtCare Mgmt, LSW - Licensed Social Worker - Care MgmtCare 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 (07/24/25)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Harrisburg, PA)
    …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + 5...experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing… more
    Prime Therapeutics (09/04/25)
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  • Appeals and Grievances Clinical Specialist…

    Healthfirst (PA)
    …Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management /case management . ... This position is 100% Remote . We are hiring for the following schedules...process + Additional duties as assigned Minimum Qualifications: + RN , LPN OR Dental Hygienist Preferred Qualifications: + Bachelors… more
    Healthfirst (10/02/25)
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  • Social Worker - Rural Health (Master's level,…

    St. Luke's University Health Network (Tamaqua, PA)
    …Worker (OP CM SW) is responsible for providing Social Work and care management services to out-patients and their families (occasional in-patients) as directed by ... policies and procedures of the entity and Outpatient Care Management Department. The OP CM SW provides professionally established...CM SW also collaborates with the Outpatient Care Manager RN , Community Health Worker and extender staff as needed… more
    St. Luke's University Health Network (08/13/25)
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  • Director Care Management

    Highmark Health (Pittsburgh, PA)
    …Administration, or a related field **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + Registered Nurse ( RN ) or Licensed Social Worker (LSW) + ... responsible for the development, implementation, and oversight of comprehensive care management programs and services within designated service line. This position… more
    Highmark Health (09/26/25)
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  • DRG Specialist II

    UPMC (Pittsburgh, PA)
    … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 Current licensure either in ... Friday during daylight hours. The position will be fully remote ! In this role, the DRG Specialist II will...Specialist (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… more
    UPMC (09/25/25)
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