- 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
- Humana (Harrisburg, PA)
- …community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, ... from medical records sent from Behavioral Health Facilities to obtain sufficient clinical information. The Utilization Management Behavioral Health Nurse 2 work… more
- UPMC (Pittsburgh, PA)
- …is hiring a full-time Behavioral Health UM Care Manager to support our UM Clinical Operations team. This role will primarily work Monday - Friday standard ... required.Licensure, Certifications, and Clearances: + Case management certification or approved clinical certification preferred + Registered Nurse (RN) *Current… 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
- CVS Health (Harrisburg, PA)
- …Fully Remote- WFH **Position Summary** UM Nurse Consultant Position Summary: UM Nurse Consultant Utilizes clinical experience and skills in a ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… 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
- UPMC (Coudersport, PA)
- UPMC Home Health is hiring a Registered Nurse for the area. Are you a nurse seeking a fulfilling career that allows you to deliver personalized, one-on-one ... * Earn a premium shift incentive and experience various settings as a resource nurse that floats to various locati *Care for your total well-being with UPMC's robust… 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
- UPMC (Altoona, PA)
- …INCLUDING BLAIR, BEDFORD, CAMBRIA, SOMERSET, HUNTINGDON, MIFFLIN, AND CENTRE. Are you a nurse looking for a rewarding career where you can provide direct, one-on-one ... + Earn a premium shift incentive and experience various settings as a resource nurse that floats to various locations. + Care for your total well-being with UPMC's… more
- Trinity Health (Langhorne, PA)
- …experienced Registered Nurse to join our team in Utilization Review! The UM Registered Nurse is responsible for the coordinating and facilitating all aspects ... of reimbursement as related to the clinical review and level of care. Management of all review and appeals utilizing a modified approach based on specific needs of… more
- Guthrie (Sayre, PA)
- Up To $25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse (RN) Utilization Management ( UM ) in collaboration with Care Coordination, Guthrie ... RN responsibilities include performing a variety of concurrent and retrospective UM -related clinical reviews and revenue cycle functions ensuring appropriate… 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
- St. Luke's University Health Network (Bethlehem, PA)
- …nurse license in Pennsylvania and/or New Jersey as appropriate . Maintenance of clinical competence as registered nurse . Represents the School in a positive ... The Instructor in Nursing, in collaboration with other faculty plans, evaluates clinical instruction in campus and clinical laboratories. Supports an academic… 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