- CVS Health (Harrisburg, PA)
- …full-time Utilization Management (UM) Nurse Consultant . As a Utilization Management Nurse Consultant , you will utilize clinical skills to ... reviewing written clinical records. **Key Responsibilities of the UM Nurse Consultant ** (Includes but is not limited...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Harrisburg, PA)
- …with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes clinical ... Time_ ). + Previous experience with prior authorization. + Previous experience with utilization management . + Previous experience in an acute care setting. +… more
- CVS Health (Harrisburg, PA)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Highmark Health (Camp Hill, PA)
- …+ Performs as the clinical subject matter expert for clinical, quality, care, utilization , high cost claim and population health management as the part ... stay current on health, wellness, productivity, risk and care management trends in the market place in order to...or CERTIFICATIONS** **Required** (any of the following) + Registered Nurse (RN) + Physician Assistant License - PA +… more
- UPMC (Pittsburgh, PA)
- UPMC Mercy is hiring a Full Time Programmatic Nurse Specialist to support Addiction Services! This position will work Monday-Friday during daylight hours. Preferred ... care/substance use disorders, and/or a CARN certification. Purpose: The Programmatic Nurse Specialist, a professional registered nurse , has the authority,… more
- UPMC (Harrisburg, PA)
- …infants, offering advanced respiratory support, surgical recovery, and complex medical management . The unit is staffed by a dedicated team of neonatologists, ... and rewarding areas of pediatric medicine. Purpose: The Programmatic Nurse Specialist, a professional registered nurse , has...to be successful in their role. Serve as a resource/ consultant for patients, nursing staff and other disciplines in… more
- UPMC (Pittsburgh, PA)
- …documentation within the medical record to ensure that all patient resource utilization , principal diagnosis, secondary diagnoses, and PCS procedures have been coded ... Identify and report issues and trends to the coding management . Prepare and present training when requested on accurate...System and DRG selection; OR specific knowledge as a consultant in Medical Record coding and DRG assignment required.… more
- Veterans Affairs, Veterans Health Administration (Wilkes Barre, PA)
- …Centers, Home Based Primary Care, Hospital In Home, Geriatric Evaluation Management (GEM) Clinic and Palliative/Hospice Care Service. The 2-page Resume requirement ... critical lab/diagnostic test result notifications in a timely manner Clinical Management including direct and indirect patient care: ensure all required encounters… more