- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors… more
- CVS Health (Harrisburg, PA)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... remote role open to candidates with an active RN licensure in the state in which they reside....to promote quality effectiveness of healthcare services and benefit utilization . **Required Qualifications** + Active and unrestricted RN… more
- Highmark Health (Harrisburg, PA)
- …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- St. Luke's University Health Network (Allentown, PA)
- …outpatient denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. ... Remote within local geography after orientation. JOB DUTIES AND...an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- CenterWell (Lancaster, PA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- ChenMed (Philadelphia, PA)
- …RN with bachelor's degree in a related clinical field preferred + A valid, active Registered Nurse ( RN ) license in State of employment required + Compact ... on-site at an assigned hospital daily from 9am-3pm, working remote for the remaining hours. The Acute Care Manager,...patients' progress and adjust and plan accordingly + Understanding utilization review and how to leverage with… more
- Prime Therapeutics (Harrisburg, PA)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
- Guthrie (Sayre, PA)
- …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... experience preferred. Education Licensed Registered Nurse with 5 years' experience, preferably...patient/family engagement. + Uses technology, such as tele-visits and remote monitoring capabilities, to engage patients and monitor chronic… more
- Sharecare (Harrisburg, PA)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Penn Medicine (Philadelphia, PA)
- …follow-up. Manage pay practices including accurate timecard review and approval, review and manage all overtime utilization Assists with the implementation ... work? Looking for a FT Associate Clinical Manager Ambulatory RN Location: PAH 7th and Spruce and PPMC 39th...Department: General Internal Medicine Schedule: M-F Day shift, Some Remote work possible after introductory period The Associate Clinical… more