• 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 (08/08/25)
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  • Utilization Management Nurse

    CVS Health (Harrisburg, PA)
    …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
    CVS Health (08/08/25)
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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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  • Utilization Management Clinical…

    CVS Health (Harrisburg, PA)
    …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
    CVS Health (07/31/25)
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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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  • RN Acute Case Manager - System Care…

    Guthrie (Sayre, PA)
    …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b.… more
    Guthrie (07/17/25)
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