• Manager, Utilization Management

    Evolent (Harrisburg, PA)
    …with others. **Collaboration Opportunities:** + The Manager, Client Services oversees daily utilization management and directs the medical care of our members ... in a supporting role to the Director, Intake and Utilization Management Operations. + This individual will...of project resources. **Qualifications - Required and Preferred** + RN Licenses (Active and Unrestricted) - Required + Associate's… more
    Evolent (08/14/25)
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  • Utilization Management Nurse

    CVS Health (Harrisburg, PA)
    …and work schedules may include weekends, holidays, and evening hours_ As a Utilization Management Nurse Consultant, you will utilize clinical skills ... **Required Qualifications** - 3+ years of experience as a Registered Nurse - Must have active current...of clinical experience in acute or post-acute setting - Utilization management is a 24/7 operation. Work… more
    CVS Health (08/16/25)
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  • Utilization Management Nurse

    CVS Health (Harrisburg, PA)
    …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
    CVS Health (08/16/25)
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  • SNF Utilization Management RN

    Humana (Harrisburg, PA)
    **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... determination of the appropriate courses of action. The SNF Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
    Humana (08/09/25)
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  • Utilization Management Nurse

    CenterWell (Harrisburg, PA)
    RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Harrisburg, PA)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (08/02/25)
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  • Clinical Resource Coordinator…

    Penn Medicine (Philadelphia, PA)
    …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management more
    Penn Medicine (08/13/25)
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  • Registered Nurse - Case Manager…

    WellSpan Health (Lebanon, PA)
    …**Duties and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and..., or Clinical Nursing Specialty. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or +… more
    WellSpan Health (07/22/25)
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  • Inpatient Registered Nurse

    St. Luke's University Health Network (Coaldale, PA)
    …including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... we serve, regardless of a patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for coordinating the… more
    St. Luke's University Health Network (07/17/25)
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  • RN - Registered Nurse

    Geisinger (Wilkes-Barre, PA)
    …and License(s) Accredited Case Manager within 3 years - American Case Management Association (ACMA); Licensed Registered Nurse (Pennsylvania) - ... 3 years of hire. At least one year of RN Care Management is strongly preferred. +...assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to… more
    Geisinger (08/09/25)
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