- Humana (Harrisburg, PA)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Harrisburg, PA)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Trinity Health (Darby, PA)
- …cost-effective care delivery. + Interviews patients/significant others within one working day of Utilization Management Nurse , ED Case Manager, or other ... referral to obtain data on personal, social, medical, emotional, cultural, and religious history in order to delineate problems requiring Social Work intervention and to plan appropriate services and discharge plans to the next level of care. + Collaborates… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Harrisburg, PA)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical records ... Minimum Required Qualifications: + Current licensure as a Registered Nurse , issued by the Pennsylvania Board of Nursing +...structures and related legal medical issues. + Knowledge of utilization management and quality improvement processes. +… more
- WellSpan Health (Lebanon, PA)
- …**Duties and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and...or Clinical Nursing Specialty. Preferred **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered Nurse… more
- LifePoint Health (Johnstown, PA)
- …in employment. **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN)- Case Management PRN/Hourly* **Location:** *Pennsylvania-Johnstown* ... *Registered Nurse (RN), Case Manager PRN/Hourly* Job Type:PRN/Hourly| M-Sun...PRN/Hourly* Job Type:PRN/Hourly| M-Sun 8a-430p ** *Department/Unit Summary* Case Management plays an important role in the care of… more
- Commonwealth of Pennsylvania (PA)
- Registered Nurse Supervisor Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4959797) Apply Registered Nurse Supervisor Salary $98,311.00 - ... + Benefits + Questions THE POSITION Are you a compassionate, skilled Registered Nurse interested in providing quality care for veterans and their spouses? If so,… more