- AmeriHealth Caritas (Philadelphia, PA)
- …The Clinical Care Reviewer refers the member to a Special Needs/Pediatric Shift Care Case Manager and works collaboratively with that Case Manager ... documentation of member interventions and goals. Following the shift care workflow the case is presented to the Medical Director for medical necessity review .… more
- AmeriHealth Caritas (Newtown Square, PA)
- …provides organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and ... practice initiatives in collaboration with the Corporate Medical Director(s), Utilization Management and the Vice President, Medical Affairs. ;The following… more
- ChenMed (Philadelphia, PA)
- …We're rapidly expanding and we need great people to join our team. The RN Case Manager (Community Care Nurse) is an on-site role within our Primary Care ... and post-acute facilities, as well as, their home environments. The Nurse Case Manager role also involves establishing relationships with patients' families… more
- Highmark Health (Monroeville, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... BSN **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case Management Association -… more
- Highmark Health (Monroeville, PA)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer...CERTIFICATIONS** **Required** + None **Preferred** + ACM Certification (Accredited Case Manager ) - American Case … more
- WellSpan Health (Ephrata, PA)
- …and resolve barriers for staff. **Common Expectations:** + Demonstrates knowledge of case management, utilization review and population health. Assesses ... guidance to staff on issues involving discharge planning, payer relations and utilization review . + Monitors and shares department Key Performance Indicators… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- Overview The Case Manager 's primary duty is to...combination of home care management, case management review , utilization review , social service ... by gaining access to their wellbeing needs, journey and treatment plan. The Case Manager collaborates and maintains consistent communications with internal and… more
- Penn Medicine (Lancaster, PA)
- …function and health in an appropriate environment that would support their needs. The Case Manager functions within the full scope of practice to include the ... to encompass coordination of care across the continuum. The Case Manager applies the processes of assessment,...Bachelor's degree in Nursing BSN . + Knowledge of utilization review or managed care. + Care… more
- LifePoint Health (Johnstown, PA)
- …plays an important role in the care of hospitalized patients. Our team of RN Case Managers, Social Workers, Utilization Review staff, and Discharge Planners ... *Registered Nurse (RN), Case Manager * Job Type:Full-time|M-F 8a-430pm, rotating Saturdays and On-call ** *Department/Unit Summary* Case Management… more
- Geisinger (Danville, PA)
- …of experience and build a rewarding, lasting career by joining us as a RN Case Manager - Care Coordinator for the Geisinger Medical Center Inpatient Care ... Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for...universal life and pet and legal insurance Registered Nurse Case Manager Hours: 40 hours per week;… more
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