- Penn State Health (Hershey, PA)
- …medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** RN Registered Nurse Utilization Management Specialist - Utilization ... for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATION(S):** + Bachelors Degree in Nursing… more
- CenterWell (Harrisburg, PA)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... community resourcesParticipates and drives accountability in daily interdisciplinary meetings Utilization Management :Adheres to guidelines to satisfy 3rd party… more
- Humana (Harrisburg, PA)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director… more
- Sharecare (Harrisburg, PA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- LifePoint Health (Johnstown, PA)
- …care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff, and Discharge Planners assure that payer requirements are ... harassment in employment. **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN)- Case Management PRN/Hourly* **Location:** *Pennsylvania-Johnstown*… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience preferred. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the plan 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 required. Prefer financial experience ... regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and… more
- Evolent (Harrisburg, PA)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Evolent (Harrisburg, PA)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more