- WellSpan Health (York, PA)
- …collection and analysis of utilization patterns and denied cases. + Supports the Utilization Management Nurse with case research and analysis. + Works ... GED Required + Associates Degree Preferred **Work Experience:** + 2 years Utilization Management . Required **Knowledge, Skills, and Abilities:** + Basic computer… more
- Humana (Harrisburg, PA)
- …help us put health first** The Utilization Management Registered 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 varied and frequently… more
- CenterWell (Harrisburg, PA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
- CenterWell (Harrisburg, PA)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
- UPMC (Pittsburgh, PA)
- …Advisors at each hospital in their region. Key Responsibilities + Leadership & Management **: + Oversee Utilization Management (UM) across assigned hospitals, ... effectively with hospital administration and clinical teams. + Experience in utilization management and care coordination. + In-depth understanding of… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... to share this rewarding and **REMOTE RN** role! This role will focus primarily on utilization review which is why we are seeking individuals who have between 3 to 5… more
- WellSpan Health (York, PA)
- …+ 2 years Recent acute care experience. Required + Utilization management , case management , or clinical nursing specialty. Preferred **Licenses:** ... **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine... Nurse Upon Hire Required or + Registered Nurse Multi State License Upon Hire Required 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
- Guthrie (Sayre, PA)
- …aspects for Care Coordination including, but not limited to Case Management , Utilization Review (UR), Utilization Management (UM), and Medical Social ... of knowledge in and experience of payer contract language, as it relates to utilization management . Can navigate through the requirements imposed by all payers.… more