- CenterWell (Harrisburg, PA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional… more
- CenterWell (Harrisburg, PA)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience +… more
- Guthrie (Sayre, PA)
- …five (5) years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management ... for alternate levels of care . The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration… more
- UPMC (Pittsburgh, PA)
- …healthcare resource utilization , case management interventions. Update the plan of care following review and communicate recommendations to the member and ... for? UPMC Health Plan is hiring a full-time Clinical Care Manager to support our partnership with... provider that promotes healthy lifestyles, closes gaps in care , and reduces unnecessary ER utilization and… more
- Highmark Health (Harrisburg, PA)
- …and interdisciplinary team partners including but not limited to: appropriateness of care , documentation requirements, utilization review principles and ... OVERVIEW:** This job has responsibility for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum.… more
- ChenMed (Philadelphia, PA)
- …assigned hospital daily from 9am-3pm, working remote for the remaining hours. The Acute Care Manager , Complex Care (RN) is responsible for achieving positive ... Management/Disease Management program with verbal introduction to their Community Care Manager for home visit once discharge...patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with… more
- Geisinger (Wilkes-Barre, PA)
- …to build a rewarding, lasting career with impact. Join us as an RN Case Manager in Care Coordination to strengthen that impact. Apply to learn more, we ... Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for...to hearing from you! Job Duties The RN Case Manager assesses, plans, implements, coordinates, monitors and evaluates all… more
- UPMC (Pittsburgh, PA)
- …with a Pennsylvania RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and ... UPMC Health Plan is hiring a flex full-time UM Care Manager to support our UM Clinical...appropriate setting and cost - effective manner. **Responsibilities:** + Review and document clinical information from health care… more
- Aveanna Healthcare (Erie, PA)
- Care Experience Manager ApplyRefer a FriendBack Job Details Requisition #: 206834 Location: Erie, PA 16503 Category: Administrative/Clerical Salary: $45,000.00 ... health and wellbeing of children and their families. The Care Experience Manager (CEM) is accountable for...clinician, and within insurance authorization. - Responsible to manage utilization of direct care team members based… more
- UPMC (Pittsburgh, PA)
- The Care Manager Associate (CMA) position will be part of the UPMC Health Plan's Community Services Community Paramedic Team. The team expands paramedic roles ... the CMA's collaborations, practical comprehension and hands-on experience in clinical care / utilization management will result by collecting and assisting with… more