- Guthrie (Sayre, PA)
- …Experience: + Two years of recent clinical supervisory experience or charge nurse experience desired Essential Functions: + RESOURCE UTILIZATION ; Considers ... Manager / Director informed of clinical issues, triage problems, staffing issues, and risk management concerns. Acts on behalf of nurse Manager / Director in… more
- ChenMed (Philadelphia, PA)
- …clinical work experience required + A minimum of one (1) year of utilization review and/or case management , home health, hospital discharge planning experience ... through external providers and healthcare systems. The Acute Care Nurse is an important member of the Complex Care...plans. The success of this role is determined by management of patients in hospital to ensure patients receive… more
- Trinity Health (Darby, PA)
- …Type:** Part time **Shift:** **Description:** **RN Care Manager - Utilization Management ** **Location:** Mercy Fitzgerald **Department:** Care Coordination ... Fitzgerald is seeking a dedicated **RN Care Manager - Utilization Management ** to join our Care Coordination...in Nursing (BSN) required. + **Licensure/Certification:** + Active Registered Nurse license in the State of Pennsylvania required. +… more
- Penn Medicine (Philadelphia, PA)
- …skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team, and physician ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the...community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management… more
- Magellan Health Services (Somerset, PA)
- …Strong organization, time management and communication skills.* Knowledge of utilization management procedures, mental health and substance abuse community ... time management and communication skills. Knowledge of utilization management procedures, mental health and substance...Social Worker - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care MgmtCare… more
- 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 required. Prefer financial experience ... 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
- Highmark Health (Natrona Heights, PA)
- …Work + 5 years in Complex Transition Management + 1 year in a management or leadership capacity + Registered Nurse **OR** Licensed Social Worker + Strong ... OVERVIEW:** Provides operational and strategic leadership for Hospital/facility Care Management Department. Collaborates with nursing and clinical leaders to assure… more
- Select Medical (Mckeesport, PA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (York, PA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Highmark Health (Monroeville, PA)
- …effective resource utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization , and patient/family ... Incumbents will utilize nationally recognized standards of practice for case management by collaborating with providers, clinical teams, health plans, and external… more