- Penn State Health (Hershey, PA)
- …or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** RN Registered Nurse Utilization Management Specialist - Utilization Management ... for maintaining compliance with the CMS Conditions of Participation for Utilization Management. **MINIMUM QUALIFICATION(S):** + Bachelors Degree in Nursing or… more
- CVS Health (Harrisburg, PA)
- …opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with productivity and… more
- CenterWell (Harrisburg, PA)
- …Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Commonwealth of Pennsylvania (PA)
- …care. + C. I have professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance ... facility. + C. I have experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or… more
- Centene Corporation (Harrisburg, PA)
- …discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families ... regrading BH utilization process + Interacts with BH healthcare providers as...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Penn Medicine (Philadelphia, PA)
- …quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources, ... community resourcesParticipates and drives accountability in daily interdisciplinary meetings Utilization Management:Adheres to guidelines to satisfy 3rd party payer… more
- WellSpan Health (Ephrata, PA)
- …0800 to 1630 **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources ... address patient discharge needs. Provides leadership in the integration of utilization and case management principles. **Duties and Responsibilities** + Reviews… more
- WellSpan Health (Lebanon, PA)
- …Weekend rotation **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of ... address patient discharge needs. Provides leadership in the integration of utilization and case management principles. **Duties and Responsibilities** + Reviews… more
- WellSpan Health (York, PA)
- …am to 7 pm **General Summary** Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources ... patient care transition needs. Provides leadership in the integration of utilization and case management principles throughout the hospital. **Duties and… more