- Humana (Harrisburg, PA)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...Time **Required Qualifications** + Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in… more
- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Harrisburg, PA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Harrisburg, PA)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... treatment, care or services for members utilizing Home Health and Skilled Nursing Facility services. This team sits in the Home Solutions organization and… more
- WellSpan Health (Lebanon, PA)
- …Acute Care experience. Required + Field of experience in Utilization Management , Case Management , or Clinical Nursing Specialty. Preferred **Licenses:** ... and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for... Nurse Upon Hire Required or + Registered Nurse Multi State License Upon Hire Required and +… 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 ... Arts (BA) degree in addition to a degree in Nursing . A registered nurse with five (5)...admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b.… more
- Banner Health (PA)
- …staff relations, and the charging/billing is required. A working knowledge of utilization management and patient services is required. A working knowledge ... best place to work and receive care. As an Associate Manager of RN Denials Management , you will be an integral part of leadership within the team. During your… more
- UPMC (Pittsburgh, PA)
- …Nurse (RN) with an active PA License required + BSN Preferred + Case management nursing preferred. + Minimum 1 year of health insurance experience preferred. ... Nurse Clinical Care Coordinator is responsible for delivering nursing assessments and evaluations within recognized standards of ...+ 1 year of experience in clinical, utilization management , home care, discharge planning, and/or… more
- UPMC (Pittsburgh, PA)
- …+ Three (3) years experience in health care related field. + Previous care management experience including: Utilization Management , Care Management or ... Purpose: Do you have experience with Care Management processes? Are you looking to share your...Perform other duties as assigned. + Bachelor's Degree in nursing or science and active PA RN License OR… 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 . + Prefer financial experience related ... patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials...+ Must be a graduate of an accredited, professional nursing program. + Must have current RN license to… more