- Humana (Dover, DE)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Dover, DE)
- …Must be willing and able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work schedules will include weekend/holiday ... zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required +...+ Managed Care experience + Discharge planning experience + Utilization Management experience **Education** Associates Degree or… more
- CVS Health (Dover, DE)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...preferred. + An active DE or compact state Registered Nurse (RN) license in good standing is required. +… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Trinity Health (Darby, PA)
- …cost-effective care delivery. + Interviews patients/significant others within one working day of Utilization Management Nurse , ED Case Manager, or other ... referral to obtain data on personal, social, medical, emotional, cultural, and religious history in order to delineate problems requiring Social Work intervention and to plan appropriate services and discharge plans to the next level of care. + Collaborates… more
- Humana (Dover, DE)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- Zurich NA (Dover, DE)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Veterans Affairs, Veterans Health Administration (Coatesville, PA)
- …EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Nurse Practitioner reports to the Associate Chief of Staff-Primary Care. He/she ... in a collaborative relationship with his/her clinical physician supervisors. The Nurse Practitioner provides a full range of services emphasizing quality,… more
- Evolent (Dover, DE)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- ChenMed (Philadelphia, PA)
- …with guidelines. This position may require participation in risk and quality management programs, clinical meetings and other meetings.The Nurse Practitioner ... ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required that promote… more
- Trinity Health (Newtown Square, PA)
- …years previous experience required 5-8 years previous experience preferred Knowledge of utilization management ie acuity. Ability to define appropriate level of ... includes: Bed Planning, Case Management , Leadership, Transfer Center, and Utilization Management ** **Our Commitment to Diversity and Inclusion** Trinity… more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review) Strong computer skills Ability ... abstraction & entry of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer equipment, encrypted zip drives… more
- Sharecare (Dover, DE)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Trinity Health (Pennsauken, NJ)
- …behavior. 10. In light of a disaster will know your disaster recovery, crisis management and business continuity plans and act within your role that is developed ... Committee if required. Involved in the development and implementation of QAPI activities. Nurse Case Manager Page 2 of 4 15. Coordinate hospital discharges in… more
- ChenMed (Philadelphia, PA)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- ChenMed (Philadelphia, PA)
- …expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient care advice ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- Highmark Health (Dover, DE)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Dover, DE)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Penn Medicine (Bala Cynwyd, PA)
- …Functions monitored will include, but are not limited to, nursing case management , regulatory compliance, direct clinical care, new product and service development, ... and management of Human Resources related items for RN staff...that all regulatory requirements are met. + Ensures effective utilization of materials, staff, and financial resources. + Sponsors… more