- Penn Medicine (Philadelphia, PA)
- …the 12 hour shifts but are fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the perfect transition career for you, and ... will bring you joy and fulfillment. The HUP Nurse Case Manager position creates an exciting opportunity for experienced nurses to expand their knowledge and apply it… more
- Guthrie (Troy, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration...in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- Highmark Health (Monroeville, PA)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care...as an educational resource to all AHN staff regarding utilization review practice and governmental commercial payer… more
- UPMC (Pittsburgh, PA)
- …promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, ... and other health plan and system departments as appropriate. + Review member's current medication profile; identify issues related to medication adherence,… more
- Highmark Health (Monroeville, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management of readmissions,… more
- LifePoint Health (Roaring Spring, PA)
- Conemaugh Nason Medical Center is seeking a part-time Registered Nurse for our Medical/Surgical Unit. The Staff Nurse has authority and accountability for ... making is based on his/her knowledge or skill level as determined by the Nurse Manager/Clinical Supervisor. The Staff Nurse will utilize the nursing process to… more
- Penn Medicine (Philadelphia, PA)
- …be a seasoned med/surg nurse with a minimum of 5 years' experience in Utilization review and 3 years of experience in the Transfer Center.** Summary: + ... quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources,… more
- UPMC (Pittsburgh, PA)
- …RN license. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... based on information obtained from interaction with members and providers. + Review and document clinical information from health care providers including clinical… more
- Amergis (Pittsburgh, PA)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Essential… more