- 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
- CVS Health (Harrisburg, PA)
- …we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... Time_ ). + Previous experience with prior authorization. + Previous experience with utilization management . + Previous experience in an acute care setting. +… 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 (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 ... Eligible **General Summary** Provides professional nursing services to individuals in the home through a process of nursing assessment, planning, care and evaluation… 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 ... 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 (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
- 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… more
- Humana (Harrisburg, PA)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals...Friday; 8:00 am-5 pm Eastern Standard Time **Work at Home Requirements** To ensure Hybrid Office/ Home associates'… 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 ...1800, Adams County includes the borough of Gettysburg, Pennsylvania. Home to more than 100,000 residents, the town is… 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
- WellSpan Health (Hanover, 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
- CenterWell (Lancaster, PA)
- …+ Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. + Home ... : On-site **Branch Location** : Lancaster, PA **This is not a remote or work-from- home position. This position requires you to sit on-site at our Lancaster, PA… 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