- Humana (Harrisburg, PA)
- … licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... review depending on case findings. + Educates providers on utilization and medical management processes. + Enters...health or rehab + Certification in Case Management (CCM) or Managed Care Nursing (CMCN)… more
- Geisinger (Danville, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... Specialty Training Program- Nursing (Required) Experience Minimum of 3 years- Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse … 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
- CenterWell (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more
- UPMC (Pittsburgh, PA)
- …of care. + Minimum of 2 years of experience in a clinical setting and case management nursing required. + BSN preferred. + Minimum 1 year of health insurance ... nursing background in outpatient, home health, or case management ? Do you have an interest in health insurance,...experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or… more
- Magellan Health Services (Newtown, PA)
- …Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...Work Experience - Preferred Education - Required Associate - Nursing , Bachelor's - Social Work, Master's - Social Work… more
- Genesis Healthcare (York, PA)
- …years of clinical nursing experience is required. Prior experience in utilization review, case management or discharge planning is required. Prior experience ... in the state where employment occurs is required. Bachelor's Degree in Nursing preferred. Certified Case Management (CCM) or related clinical certification… more
- St. Luke's University Health Network (Bethlehem, PA)
- …, including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among ... The RN Care Manager coordinates the overall progression of care, resource utilization , and discharge planning for designated patient populations across the continuum… more
- Select Medical (Mckeesport, PA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (York, PA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more