• Utilization Management Nurse…

    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 (09/12/25)
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  • SNF Utilization Management RN…

    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
    Humana (09/12/25)
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  • Utilization Management Nurse

    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
    Humana (10/18/25)
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  • Clinical Registered Nurse…

    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
    Cognizant (10/07/25)
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  • Utilization Management…

    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
    Humana (10/10/25)
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  • Registered Nurse - Case Manager - PRN

    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
    WellSpan Health (10/15/25)
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  • RN Acute Case Manager - System Care…

    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 (10/15/25)
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  • Case Manager RN - Evangelical - Days

    WellSpan Health (Lewisburg, PA)
    …acute care experience Required + Field of Experience in Utilization Management , Case Management , or Clinical Nursing Specialty. Preferred **Licenses:** ... **Essential Functions:** + 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
    WellSpan Health (10/17/25)
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  • Care Management Nurse - Nights

    WellSpan Health (York, PA)
    …- day shift_** **General Summary** Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use ... address patient care transition needs. Provides leadership in the integration of utilization and care management principles throughout the hospital. **Duties and… more
    WellSpan Health (10/17/25)
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  • Weekend Nurse Clinical Care Coord…

    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 (10/11/25)
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