- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Weekend 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
- 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
- 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
- Cognizant (Harrisburg, PA)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... 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 Appeals and… 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 ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- CVS Health (Harrisburg, PA)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Penn State Health (Hershey, PA)
- …for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATION(S):** + Bachelors Degree in Nursing ... discrimination._ **Union:** SEIU Healthcare Pennsylvania **Position** Specialist (Part-time) - Utilization Management **Location** US:PA: Hershey | Nursing |… more
- Centene Corporation (Harrisburg, PA)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- WellSpan Health (York, PA)
- …- day shift_** **General Summary** Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use ... address patient care transition needs. Provides leadership in the integration of utilization and care management principles throughout the hospital. **Duties and… more
- Sharecare (Harrisburg, PA)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... 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 (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 ... year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical ...Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License Upon Hire Required or +… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… 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 Knowledge of… more
- WellSpan Health (Gettysburg, PA)
- …plan of care, the patient's diagnosis, corporate policy and procedures and the Nurse Practice Act. Carries primary care management functions for assigned ... patient and/or care givers in performing specific procedures. + Performs case management functions, when assigned as primary clinician. + Participates in patient… more
- WellSpan Health (York, PA)
- … management , all components of advanced cardiac life support, pacemaker/ICD management , IABP management , CRRT utilization , and Impella. **General ... clinical standards of the hospital. Acts as a primary nurse for patients on the unit. Coordinates care planning...clinical standards of the hospital. Acts as a primary nurse for patients on the unit. Synthesizes patient data… more
- WellSpan Health (Gettysburg, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical ...Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License Upon Hire Required or +… 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 ... year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical ...Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License Upon Hire Required or +… 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 ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Genesis Healthcare (Camp Hill, PA)
- …to achieve patient goals and minimize rehospitalizations; 4.4. Actively participates in Utilization Management or InterdisciplinaryCare Management Meeting to ... Manager, ADON or ADON - Unit, or Director of Nursing ( Nurse Leader), the Registered Nurse (RN) delivers efficient and effective nursing care while achieving… more