• Clinical UM Nurse

    CenterWell (Harrisburg, PA)
    …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
    CenterWell (11/12/25)
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  • UM Care Manager (RN)

    UPMC (Pittsburgh, PA)
    UPMC Health Plan is hiring a full-time UM Care Manager to support our UM Clinical Operations team. This role will primarily work Monday - Friday standard ... proficiency required.Licensure, Certifications, and Clearances:Case management certification or approved clinical certification preferred + Registered Nurse (RN)… more
    UPMC (11/13/25)
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  • UM Coordinator - Utilization Management

    Penn State Health (Hershey, PA)
    … Nurse or Specialist, the Utilization Management Coordinator supports the UM process by obtaining authorizations, reviewing clinical documentation in the ... of health plan insurance criteria. Additionally, the coordinator must have clinical knowledge to assess diagnoses, current conditions, and previous treatments… more
    Penn State Health (11/11/25)
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  • Nurse

    Veterans Affairs, Veterans Health Administration (Lebanon, PA)
    …functions within the scope of the CPAC for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and collaboration to ... Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the ...of funds through systematic evaluation and analytical review of clinical information. Responsibilities The Revenue Utilization Review (RUR) Registered… more
    Veterans Affairs, Veterans Health Administration (11/04/25)
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  • Utilization Management Nurse - Home…

    Humana (Harrisburg, PA)
    …us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation… more
    Humana (09/12/25)
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  • Home Health Professional Staff Nurse - Cole

    UPMC (Coudersport, PA)
    UPMC Home Health is hiring a Registered Nurse for the area. Are you a nurse seeking a fulfilling career that allows you to deliver personalized, one-on-one ... * Earn a premium shift incentive and experience various settings as a resource nurse that floats to various locati *Care for your total well-being with UPMC's robust… more
    UPMC (09/13/25)
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  • Telephonic Nurse Case Manager

    Humana (Harrisburg, PA)
    …a part of our caring community and help us put health first** The Telephonic Nurse Case Manager will be a member of the In-Home Case Management Team, providing a ... beneficiary's capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care....and to enhance quality of medical care. The **Telephonic Nurse Case Manager** will collect and document data to… more
    Humana (11/06/25)
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  • Registered Nurse Home Health

    UPMC (Altoona, PA)
    …INCLUDING BLAIR, BEDFORD, CAMBRIA, SOMERSET, HUNTINGDON, MIFFLIN, AND CENTRE. Are you a nurse looking for a rewarding career where you can provide direct, one-on-one ... + Earn a premium shift incentive and experience various settings as a resource nurse that floats to various locations. + Care for your total well-being with UPMC's… more
    UPMC (11/13/25)
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  • Registered Nurse - Utilization Review

    Trinity Health (Langhorne, PA)
    …experienced Registered Nurse to join our team in Utilization Review! The UM Registered Nurse is responsible for the coordinating and facilitating all aspects ... of reimbursement as related to the clinical review and level of care. Management of all review and appeals utilizing a modified approach based on specific needs of… more
    Trinity Health (11/13/25)
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  • RN Utilization Management - System Care Management…

    Guthrie (Sayre, PA)
    Up To $25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse (RN) Utilization Management ( UM ) in collaboration with Care Coordination, Guthrie ... RN responsibilities include performing a variety of concurrent and retrospective UM -related clinical reviews and revenue cycle functions ensuring appropriate… more
    Guthrie (11/11/25)
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