- Humana (Harrisburg, PA)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** 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
- WellSpan Health (Lebanon, PA)
- …**General Summary** Provides comprehensive family-oriented nursing services to individuals in the home setting by use of the nursing process in accordance with ... the established plan of care, corporate policy and procedures, and the Nurse Practice Act. **Duties and Responsibilities** **Essential Functions:** + Participates in… 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...develops a discharge plan, and coordinates discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients,… more
- Sharecare (Harrisburg, PA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...minimum. + This position will be based in a home office which must satisfy all HIPAA requirements. Sharecare… more
- WellSpan Health (Mount Gretna, PA)
- …+ Engages assigned patients using Motivational Interviewing strategies in the active management of their health by encouraging participation in their care and ... planning. Assistance, as needed, with patient understanding of medication management , outpatient follow up treatment, discharge transportation needs, and identifying… more
- Health Advocates Network (Harrisburg, PA)
- …setting, behavioral health setting, drug and alcohol setting, managed care, quality management / utilization review or other related clinical experience; or An ... R&E Nurse - Med Care Services- Advanced **Pay Rate:** $28...(MA), health care services, human services, long term care, utilization review, or knowledge of home care… more
- Humana (Harrisburg, PA)
- …as Interqual, etc.) **Preferred Qualifications** + Utilization Review/Quality Management experience + BA/BSN degree **Work-At- Home Requirements** + WAH ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… more
- Lincoln Financial (Harrisburg, PA)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at ...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… 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 ... Experience:** + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi… more
- Evolent (Harrisburg, PA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- WellSpan Health (York, PA)
- …leadership and Medical Group practice experience. Required + Lean Daily Management experience. Preferred **Licenses:** + Licensed Registered Nurse Upon ... safety and efficient care. Assists the Director of Clinical Operations in management of staff to deliver high quality, patient-centered care. Assists with directing… more
- UPMC (Harrisburg, PA)
- Registered Nurse Home Health Harrisburg Are you a nurse looking for a rewarding career where you can provide direct, one-on-one patient care? UPMC Home ... caring, skilled, and compassionate registered nurses to join our home health nursing team! You'll work in a ...plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians'… more
- WellSpan Health (Lebanon, PA)
- PRN Day Shift Mon-Fri 8a-430pm Not needed on Holidays or weekends ** Home Health experience required** **CNA required** **General Summary** Provides the following ... a written plan of care developed by the primary nurse or therapist. + Performs household services to maintain...of care. + Provides a stabilizing influence within the home , thereby promoting the mental health of the patient… more
- Sharecare (Harrisburg, PA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more