• Clinical Reviewer, Nurse

    Evolent (Harrisburg, PA)
    Registered Nurse + Associate or Bachelors in Nursing (Must be a Registered Nurse ) + Experience as an RN in a Pain MNGT setting is preferred. + Strong ... , you will be a key member of the utilization management team. We can offer you...Nurse , you will routinely interact with leadership and management staff, other CR's (Clinical Reviewers), providers, office staff… more
    Evolent (08/19/25)
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  • Licensed Practical Nurse - Pain…

    WellSpan Health (York, PA)
    …or + Licensed Practical Nurse Multi State License Upon Hire Required or + Licensed Registered Nurse Upon Hire Required or + Registered Nurse Multi ... of patient care between visits. + Assists in the management of patient utilization of health care...identified. + WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for… more
    WellSpan Health (07/22/25)
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  • Home Health Professional Staff Nurse - Cole

    UPMC (Coudersport, PA)
    …+ Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Driver's License + Registered Nurse ( RN ) OR Temporary Practice Permit (TPP) + Act ... UPMC Home Health is hiring a Registered Nurse for the area. Are...plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians'… more
    UPMC (06/14/25)
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  • DRG Specialist

    UPMC (Pittsburgh, PA)
    … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 *Current licensure either in ... are accurately coded and sequenced according to coding and compliance guidelines. + Meet with coding management ...Specialist (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… more
    UPMC (06/11/25)
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  • Clinical Reviewer, Nurse -Surgery

    Evolent (Harrisburg, PA)
    …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
    Evolent (08/19/25)
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  • Supervisor - Home Health - Days

    WellSpan Health (York, PA)
    …nursing or therapy experience with an emphasis in home care. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered Nurse ... with team members to identify root cause and countermeasures.* Holds In Episode Management meetings on a regularly scheduled basis with individual staff to ensure… more
    WellSpan Health (07/08/25)
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  • Home Health Nurse Erie County

    UPMC (Erie, PA)
    …+ Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Driver's License + Registered Nurse ( RN ) OR Temporary Practice Permit (TPP) *Current ... establish patients' plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians' orders and… more
    UPMC (07/30/25)
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  • Home Health Nurse Bethel Park OB/Peds

    UPMC (Seven Fields, PA)
    …+ Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Driver's License + Registered Nurse ( RN ) OR Temporary Practice Permit (TPP) + Act ... establish patients' plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians' orders and… more
    UPMC (07/30/25)
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  • Supervisor, Clinical Care Coordination

    UPMC (Mckeesport, PA)
    …OR Licensed Social Worker (LSW) OR Other Healthcare Professional Licenses for Discharge Planning OR Registered Nurse ( RN ) + Act 33 with renewal + Act 34 ... Collaborate with medical staff and external agencies + Work alongside the Unit Director, RN Clinician and Addiction Medicine Nurse Liaison to ensure patients are… more
    UPMC (08/09/25)
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  • Director Care Management

    Highmark Health (Natrona Heights, PA)
    … + 1 year in a management or leadership capacity + Registered Nurse **OR** Licensed Social Worker + Strong communication and collaboration skills ... OVERVIEW:** Provides operational and strategic leadership for Hospital/facility Care Management Department. Collaborates with nursing and clinical leaders to assure… more
    Highmark Health (06/28/25)
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