- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- Evolent (Harrisburg, PA)
- …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
- Prime Therapeutics (Harrisburg, PA)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... the future of pharmacy with us. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for performing… more
- UPMC (Pittsburgh, PA)
- …services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization . This role also acts as a SME for the department in ... representing management in meetings, training new staff and auditing peers....not limited to analysis of controlled substance prescribing and utilization to identify potential clinical care issues; prepayment review… more
- Highmark Health (Monroeville, PA)
- …and third party payers. + Maintains a working knowledge of care management , care coordination changes, utilization review changes, authorization changes, ... relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …within the KidsPeace medical community when necessary. + Medication Management - Prescribe and monitor medications within established pediatric standards. ... & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary collaboration/supervision… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …limit the use of restraints or other safety measures. Medication Management - Prescribe medications within established psychiatric practice standards, monitor ... & Supervision - Assume a leadership role regarding the clinical management of patients/clients in programs assigned. Establish as necessary collaboration/supervision… more