• Utilization Management Nurse

    CenterWell (Harrisburg, PA)
    …and the healthcare industry as a whole. 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...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
    CenterWell (08/02/25)
    - Related Jobs
  • Care Nurse Coordinator- RN

    WellSpan Health (Mount Gretna, PA)
    …2 years Nursing experience and recent behavioral health experience required **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered ... care and treatment progress. + Participates in daily communication with primary nurse , communicating any clinical concerns and assist in developing an action plan… more
    WellSpan Health (05/31/25)
    - Related Jobs
  • Clinical Care Manager ( RN ) - Shadyside

    UPMC (Pittsburgh, PA)
    …Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Certified Case Manager (CCM) + Driver's License + Registered Nurse ( RN ) + Act 33 with renewal + Act 34 ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
    UPMC (07/19/25)
    - Related Jobs
  • Discharge Planning RN Case Manager (FT)…

    Penn Medicine (Philadelphia, PA)
    …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources,… more
    Penn Medicine (08/07/25)
    - Related Jobs
  • Part-Time RN - Medical/Surgical

    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
    LifePoint Health (08/09/25)
    - Related Jobs
  • Wound and Skin Health Team Lead, RN

    Genesis Healthcare (Sinking Spring, PA)
    …ensuring a smooth and well-prepared transition for new residents. *Lead the team review of all new patient admissions and readmissions for skin integrity needs, ... and goal setting. *Manage specialty support surfaces, ensuring appropriate utilization , collaborating on audits, and leading quality improvement initiatives related… more
    Genesis Healthcare (08/01/25)
    - Related Jobs
  • Associate Clinical Manager Ambulatory RN

    Penn Medicine (Philadelphia, PA)
    …follow-up. Manage pay practices including accurate timecard review and approval, review and manage all overtime utilization Assists with the implementation ... you living your life's work? Looking for a FT Associate Clinical Manager Ambulatory RN Location: PAH 7th and Spruce and PPMC 39th and Market Department: General… more
    Penn Medicine (08/07/25)
    - Related Jobs
  • Registered Office Nurse ( RN

    Penn Medicine (Lancaster, PA)
    …Monday through Friday. RNs take turns starting at 8:00am so there is one RN available in the office until the others arrive at 8:30am. **POSITION SUMMARY:** ... physiologic, psychological, and cognitive functions, through patient/provider office visits, nurse visits, and telephone triage. Collaborates with Physician and… more
    Penn Medicine (08/07/25)
    - Related Jobs
  • Clinical Specialist LPN/ RN , Disability…

    Guardian Life (Bethlehem, PA)
    As the **Clinical Specialist LPN/ RN , Disability Claims** you will perform necessary outreaches to claimants or treating providers to obtain certification dates, ... individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to… more
    Guardian Life (07/03/25)
    - Related Jobs
  • Denials Management Specialist ( RN

    St. Luke's University Health Network (Allentown, PA)
    …denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. Remote ... be a graduate of an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania or seeking Pennsylvania license… more
    St. Luke's University Health Network (05/14/25)
    - Related Jobs