- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... setting **Preferred** + Experience in UM/CM/QA/Managed Care + Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Penn Medicine (Lancaster, PA)
- …6:30am-9am. No holidays _Penn Medicine Lancaster General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this ... we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible...assigned. **Minimum Required Qualifications:** + Current licensure as a Registered Nurse , issued by the Pennsylvania Board… more
- Cognizant (Harrisburg, PA)
- …have to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- WellSpan Health (York, PA)
- …2 years of RN experience required + Field of Experience in Utilization Management , Case Management , or Clinical Nursing Specialty. Preferred ... **Essential Functions:** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for...**Licenses:** + Licensed Registered Nurse … more
- 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
- 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… more
- St. Luke's University Health Network (Sellersville, 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 (Bethlehem, PA)
- …including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... an nurse or a social worker The Registered Nurse or Social Worker Care Manager...discharge interventions accordingly. + Actively addresses and monitors resource utilization and documents delays as appropriate. + Identifies patients… 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 ... Experience Minimum of 2 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania; Basic Life… more