- Penn Medicine (Philadelphia, PA)
- …skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team, and physician ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the...community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Highmark Health (Monroeville, PA)
- …advisor and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization ... the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care...as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care… more
- UPMC (Pittsburgh, PA)
- Are you an experienced Pediatric nurse with case management experience? We have a unique opportunity that may be a perfect fit for you! UPMC Health Plan is ... by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care… more
- Highmark Health (Monroeville, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... effective resource utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization , and patient/family… more
- Penn Medicine (Radnor, PA)
- …including accurate timecard review and approval, reviews and manages all overtime utilization . + Skills and Abilities: + Must be able to listen supportively to ... accurate timecard review and approval, reviews and manages all overtime utilization . + Assists with the implementation of change management strategies within… more
- Commonwealth of Pennsylvania (PA)
- …Do you enjoy learning and implementing new software applications to increase utilization review efficiencies and reporting? The Office of Mental Health ... Division Code 00211550 Bureau / Division Bureau of Quality Management and Data Review /Clinical Review ...Services is currently looking to hire a self-motivated Registered Nurse for one of our clinical review … more
- Penn Medicine (Philadelphia, PA)
- …be a seasoned med/surg nurse with a minimum of 5 years' experience in Utilization review and 3 years of experience in the Transfer Center.** Summary: + ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management … more
- Sedgwick (Harrisburg, PA)
- …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim denial, disability...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more