- 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
- Cognizant (Harrisburg, PA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals… more
- Trinity Health (Langhorne, PA)
- …consumption, and acceptable clinical outcomes, through integration and implementation of utilization management . **Minimum Requirements:** + Bachelor's degree in ... of Trinity Health Mid-Atlantic, is seeking an experienced Registered Nurse to join our team in Utilization ...related to the clinical review and level of care. Management of all review and appeals utilizing… more
- AmeriHealth Caritas (Philadelphia, PA)
- …. **Responsibilities:** Under the supervision of the LTSS Manager/Director for Utilization Management , this position is responsible for providing daily ... Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational… 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