- Guthrie (Sayre, PA)
- …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... experience preferred. Education Licensed Registered Nurse with 5 years' experience, preferably in an outpatient/ambulatory setting. Bachelor's Degree in Nursing… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... based on the needs of the organization; d. Participating in utilization review activities including but not limited to development of standards, insurance… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... based on the needs of the organization; + Participating in utilization review activities including but not limited to development of standards, insurance… more
- Prime Therapeutics (Harrisburg, PA)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
- Evolent (Harrisburg, PA)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current,… more
- UPMC (Mckeesport, PA)
- …OR Licensed Social Worker (LSW) OR Other Healthcare Professional Licenses for Discharge Planning OR Registered Nurse ( RN ) + Act 33 with renewal + Act 34 ... and external agencies + Work alongside the Unit Director, RN Clinician and Addiction Medicine Nurse Liaison...Knowledge and Skills:Expertise in care management, discharge planning and utilization review processes. + Ability to build… more
- UPMC (Mechanicsburg, PA)
- …Licensed Social Worker (LSW) OR Other Healthcare Professional Licenses for Discharge Planning OR Registered Nurse ( RN ) *Current licensure either in the state ... leadership required.KNOWLEDGE AND SKILLS:Expertise in care management, discharge planning and utilization review processes. Ability to build credible and… more
- LifePoint Health (Johnstown, PA)
- …staff competencies in all areas of care management to include utilization review , transition/discharge planning, social work services. Provide specialized ... basis protected by applicable federal, state or local law. . REQUIRED: RN license . Bachelor's Degree in Nursing or Healthcare Administration. Masters Preferred… more
- Veterans Affairs, Veterans Health Administration (Butler, PA)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... Medical Center within our Community Care Section as an RN Care Manager. Community Care at the VA provides...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- CenterWell (Harrisburg, PA)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...on excellent service to others. **Required Qualifications** + Active RN license + Possession of or ability to obtain… more