- CenterWell (Harrisburg, PA)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Penn State Health (Hershey, PA)
- … Nurse or Specialist, the Utilization Management Coordinator supports the UM process by obtaining authorizations, reviewing clinical documentation in the ... of health plan insurance criteria. Additionally, the coordinator must have clinical knowledge to assess diagnoses, current conditions, and previous treatments… more
- Veterans Affairs, Veterans Health Administration (Lebanon, PA)
- …functions within the scope of the CPAC for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and collaboration to ... Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the ...of funds through systematic evaluation and analytical review of clinical information. Responsibilities The Revenue Utilization Review (RUR) Registered… more
- Humana (Harrisburg, PA)
- …us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation… 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, providing a ... beneficiary's capacity for self- care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care....and to enhance quality of medical care. The **Telephonic Nurse Case Manager** will collect and document data to… more
- Highmark Health (Harrisburg, PA)
- …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and… more
- Datavant (Harrisburg, PA)
- …recognized medical necessity criteria and standards of care, along with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed ... Practical Nurse or Registered Nurse well versed in...denials and appeal writing for inpatient admission. Experience with clinical criteria resources and payor guidelines. **You will:** +… 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 ... by education, experience, and certifications. Responsibilities: + Your role as the nurse will establish patients' plans of care in collaboration with physicians,… more
- Sharecare (Harrisburg, PA)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision… more