- 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
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Guthrie (Sayre, PA)
- …or, a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or ... of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who...in an acute care setting with strong care management, utilization review , and payer knowledge. A Case… more
- Penn Medicine (Lancaster, PA)
- …requirements being one of the following: RN : Current licensure as a Registered Nurse , issued by the Pennsylvania Board of Nursing. Bachelor's degree in ... daily access to an insured vehicle. Preferred Qualifications + Knowledge of Utilization review or managed care + Experience with home visits + Licensure with… more
- UPMC (Delmont, PA)
- …Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Certified Case Manager (CCM) + Driver's License + Registered Nurse ( RN ) + Act 33 with renewal + Act 34 ... health insurance experience required. + 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred… more
- UPMC (Pittsburgh, PA)
- …and Clearances: + Case management certification or approved clinical certification preferred + Registered Nurse ( RN ) + Act 34 *Current licensure either ... Are you an experienced Pediatric nurse with care management experience? We have a...Medicaid team. This position will be predominantly working from home and will primarily work standard daylight hours, Monday… more
- Penn Medicine (Philadelphia, PA)
- …(Outlook, Canopy, CERME, ECIN, shared drive, Internet) **Credentials:** + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... interdisciplinary care team and Physician Advisor, with timely coordination of home care, DME, placements, hospice, community resources, transportation, and quality… 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
- Penn Medicine (Philadelphia, PA)
- …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... candidate for this position must be a seasoned med/surg nurse with a minimum of 3 to 5 years...care team and Physician Advisor, with timely coordination of home care, DME, placements, hospice, community resources, transportation, and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …; **Education/ Experience:;** + Bachelor's degree or equivalent relevant experience + Unrestricted Registered Nurse ( RN ) or Physical Therapist (PT) + Valid ... Utilization Management, this position is responsible for providing daily oversight of LTSS Review Home Modification Team and staff members within the LTSS … more
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