- UPMC (Pittsburgh, PA)
- …be given to candidates with a Pennsylvania RN license. The Utilization Management ( UM ) Care Manager is responsible for utilization review of health plan ... UPMC Health Plan is hiring a full-time UM Care Manager to...Clearances:Case management certification or approved clinical certification preferred + Registered Nurse ( RN ) *Current licensure… more
- 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 ... as related to the clinical review and level of care . Management of all review and appeals utilizing a...RN License required. + CCM or Accredited Case Manager certification preferred. + Previous experience in Utilization review… more
- CenterWell (Harrisburg, PA)
- …**Use your skills to make an impact** **Required Qualifications** + Must be a licensed Registered Compact Nurse license ( RN ) with no disciplinary action and ... caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking… more
- Humana (Harrisburg, PA)
- …**Required Qualifications** + Bachelor's degree in Nurse (BSN). + Valid and unrestricted Registered Nurse ( RN ) license in the (appropriate state) with no ... desired clinical outcomes and to enhance quality of medical care . The **Telephonic Nurse Case Manager...Management programs (DM/PN) as needed, in addition to MTF UM / CM staff, physicians and providers as necessary;… more
- Veterans Affairs, Veterans Health Administration (Lebanon, PA)
- …of revenue reimbursement processes and under moderate supervision and instruction by the registered nurse manager . Responsibilities of the RUR Registered ... nurse is under the supervision of the Nurse Manager and ANM. The RUR ...Services, Compliance, Providers, Health Information Management (HIM), Utilization Management ( UM ), and Community Care . Collects, analyzes, and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …; **Education/ Experience:;** + Bachelor's degree or equivalent relevant experience + Unrestricted Registered Nurse ( RN ) or Physical Therapist (PT) + Valid ... Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care ,… more
- Highmark Health (Harrisburg, PA)
- …established industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more