- CVS Health (Harrisburg, PA)
- …Interviewing and good technological skills + Valid unrestricted independent professional behavioral health clinical license to practice per state regulations ... standard business hours. No weekends and no holidays.** Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Telephonic Nurse Case Manager will be a member of the In-Home Case Management Team, ... case management throughout the continuum of care. The case manager will offer guidance, support, and...beneficiary's capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care.… more
- Highmark Health (Harrisburg, PA)
- …Nursing **EXPERIENCE** **Required** + 7 years of any combination of clinical , case management and/or disease/condition management experience, provider operations ... panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of...interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are… more
- CVS Health (Harrisburg, PA)
- …we do it all with heart, each and every day. **Job Summary** The Care Manager -Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible ... for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH)… more
- CVS Health (Harrisburg, PA)
- …Meet regulatory requirements within specified timelines. + **Consults** with the Care Manager RN within the Care Team for clinical knowledge, medication ... decision making + **Collaborates and leverages** the Care Manager RN clinical expertise to ensure members'...and ability to effectively utilize these tools within the Case Management Specialist (CMS) role + Access to a… more
- WellSpan Health (York, PA)
- …of clinical staff; approves/disapproves scheduled time off. + Assists Manager and Clinical Operations Coordinator with interviewing, hiring, orienting, ... part of the management team, performing a variety of clinical and administrative duties related to clinical ...Diagnostic Test Tracking, Med Reconciliation and PCMN. + Assumes manager role when Practice Manager /Front Office Supervisor… more
- Highmark Health (Harrisburg, PA)
- …Clinical Social Worker (LCSW) - Non-Specific **Preferred** + ACM Certification (Accredited Case Manager ) **SKILLS** + Adult Learning: Theory and Practice + ... Description :** **JOB SUMMARY** This job delivers highly complex clinical and systems training courses, ongoing workshops in support...Work **EXPERIENCE** **Required** + 3 - 5 years in Case Management **Preferred** + 5 - 7 years in… more
- Highmark Health (Harrisburg, PA)
- …dollar and strategic contracting functions (client and GPO), develops business case and presents to senior leadership throughout organization. + Monitor contract ... of major commodity contracts for a wide array of clinical and non- clinical products and/or services. Experience...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Harrisburg, PA)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case /utilization management and/or disease/condition management experience, or… more
- CenterWell (Harrisburg, PA)
- …and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal ... Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization… more
- Sharecare (Harrisburg, PA)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... A Disease Management Nurse is supervised by an Operations Manager (OM). All Sharecare clinicians are required to participate...during the training period will be evaluated on a case by case basis and must be… more
- Highmark Health (Harrisburg, PA)
- …Is responsible for or works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify ... related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges...processes as it relates to the DRG/APC and other clinical data quality management factors. With technical direction and… more