- Trinity Health (Newtown, PA)
- …the overall performance of the team including quality patient care, financial performance, utilization management , and compliance with state and federal ... and quality standards. Working knowledge in navigating through Excel and utilization of Outlook and Word. Excellent communication and problem-solving skills.… more
- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... in accordance with applicable state, federal laws and regulatory compliance . + Implement all care management reviews...+ Experience in UM/CM/QA/Managed Care + Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization… more
- Guthrie (Sayre, PA)
- …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...admissions and short procedures by translating clinical information to Utilization Management requirements using pre ‐ determined… more
- CenterWell (Harrisburg, PA)
- … RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- 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, ... sit on-site at our Lancaster, PA branch location.** The ** RN Clinical Manager** coordinates and oversees all direct care...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- 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, ... sit on-site at our Lancaster, PA branch location.** The ** RN Clinical Manager** coordinates and oversees all direct care...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Select Medical (Erie, PA)
- …focus on resource management within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + ... what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,...**Current licensure in a clinical discipline either as a Nurse ( RN /LPN/ LVN)or a Respiratory Therapist… more
- UPMC (Harrisburg, PA)
- …+ Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Driver's License + Registered Nurse ( RN ) OR Temporary Practice Permit (TPP) + Act ... Registered Nurse Home Health Harrisburg Are...plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians'… more
- 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 ... the remaining hours. The Acute Care Manager, Complex Care ( RN ) is responsible for achieving positive patient outcomes, managing...required + A minimum of one (1) year of utilization review and/or case management , home health,… more
- Evolent (Harrisburg, PA)
- …and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals, compliance and/or grievances/complaints in a quality ... on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures while… more