- CVS Health (Harrisburg, PA)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Harrisburg, PA)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Harrisburg, PA)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... 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 … more
- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Harrisburg, PA)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Harrisburg, PA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- WellSpan Health (York, PA)
- …a culture of quality, safety and efficient care. Assists the Director of Clinical Operations in management of staff to deliver high quality, patient-centered ... leadership and Medical Group practice experience. Required + Lean Daily Management experience. Preferred **Licenses:** + Licensed Registered Nurse Upon… more
- Evolent (Harrisburg, PA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… 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 ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- WellSpan Health (Lebanon, PA)
- …Acute Care experience. Required + Field of experience in Utilization Management , Case Management , or Clinical Nursing Specialty. Preferred **Licenses:** ... and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for... Nurse Upon Hire Required or + Registered Nurse Multi State License Upon Hire Required and +… more
- WellSpan Health (Lebanon, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License… more
- WellSpan Health (York, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License… more
- CVS Health (Harrisburg, PA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- WellSpan Health (Mount Gretna, PA)
- …patient care and treatment progress. + Participates in daily communication with primary nurse , communicating any clinical concerns and assist in developing an ... **General Summary** Performs a variety of duties to facilitate quality clinical care within the Inpatient Child/Adolescent and Adult Psychiatric Units. Supports… more
- UPMC (Harrisburg, PA)
- …the nursing process. In collaboration with the health care team, the Programmatic Nurse Specialist applies expert clinical knowledge and skills to achieve ... and rewarding areas of pediatric medicine. Purpose: The Programmatic Nurse Specialist, a professional registered nurse , has... experience + Minimum of 2 years of relevant clinical specialty experience + Leadership and project management… more
- WellSpan Health (Lebanon, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License… more
- WellSpan Health (York, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License… more
- WellSpan Health (Lebanon, PA)
- …+ Informs manager of perceived problem areas related to patient care, corporate management , or community relations. + Keeps clinical skills current with nursing ... the established plan of care, corporate policy and procedures, and the Nurse Practice Act. **Duties and Responsibilities** **Essential Functions:** + Participates in… more
- Highmark Health (Harrisburg, PA)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- WellSpan Health (York, PA)
- … management , all components of advanced cardiac life support, pacemaker/ICD management , IABP management , CRRT utilization , and Impella. **General ... based on the nursing process and according to the clinical standards of the hospital. Acts as a primary... standards of the hospital. Acts as a primary nurse for patients on the unit. Coordinates care planning… more