- 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
- Highmark Health (Harrisburg, PA)
- … **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Geisinger (Wilkes-Barre, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... Case Managers - and are dedicated to elevating your nursing career. Our culture empowers you to act with...have prior RN experience in a hospital setting. Case Management experience is preferred and not required. The successful… more
- St. Luke's University Health Network (Quakertown, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... National Organization of Perinatal Social Workers is required. OR: Graduate of professional nursing program. Registered Nurse with current license to practice in… more
- St. Luke's University Health Network (Lehighton, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. . Facilitates communication among all ... National Organization of Perinatal Social Workers is required. OR: Graduate of professional nursing program. Registered Nurse with current license to practice in… more
- Highmark Health (Harrisburg, PA)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… more
- Evolent (Harrisburg, PA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- CVS Health (Harrisburg, PA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- UPMC (Pittsburgh, PA)
- …Plan is seeking a full-time Professional Care Manager, Supervisor to join our Utilization Management (UM) Clinical Operations team. This position follows a ... day-to -day care coordination functions for telephonic, clinical, or utilization management care management staff,...one year of hire or 1 year health plan management experience required + Registered Nurse (RN)… more
- UPMC (Washington, PA)
- …care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization /case management , discharge planning, Medicare, Medicaid, and ... The Manager oversees the day-to-day operations of the Case management department under the direction of the Director. The Manager is accountable for the following… more
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