- WellSpan Health (York, PA)
- …Intensive Care experience preferred + Field of Experience in Utilization Management , Case Management , or Clinical Nursing Specialty. Preferred ... **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
- Evolent (Harrisburg, PA)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Redeemer Health Home Care & Hospice (Meadowbrook, PA)
- …self-starter, enthusiastic personality. Three years of acute care experience in Care Management , Discharge Planning or Utilization management preferred. ... OVERVIEW Embark on an enriching nursing career at Redeemer Health, where you can...current RN licensure (BSN preferred)). Adheres to the Case Management Society of America (CMSA) Standards, Nurse … more
- Trinity Health (Darby, PA)
- …experience, with emphasis on medical/surgical nursing . + Experience in Case Management , Discharge Planning, and Utilization Management preferred. + ... Type:** Part time **Shift:** **Description:** **RN Care Manager - Utilization Management ** **Location:** Mercy Fitzgerald **Department:** Care Coordination… 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
- 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...Work Experience - Preferred Education - Required Associate - Nursing , Bachelor's - Social Work, Master's - Social Work… 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 ... and License(s) Accredited Case Manager within 3 years - American Case Management Association (ACMA); Licensed Registered Nurse (Pennsylvania) - RN_State of… 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
- 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
- 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