- 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
- The Cigna Group (Philadelphia, PA)
- …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make appropriate referrals to social work, pharmacy, case management and engagement _Other telephonic patient care...needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with Microsoft Office… more
- Spectrum Health Services (Philadelphia, PA)
- …medical, behavioral health and/or psychosocial problems through practice and home-based visits and telephonic support on a care management or case management ... care team, assesses patients for risk of adverse health outcomes, inappropriate utilization , and monitors the impact of care management interventions. Essential… 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** :...(MA), health care services, human services, long term care, utilization review, or knowledge of home care Knowledge of… more
- WellSpan Health (York, PA)
- … Management in the provision of leadership and integration of utilization management principles throughout the Hospital. Duties and Responsibilities Essential ... data analysis as required. + Develops and initiates educational programs regarding utilization management principles and CM when needed. Required for All Jobs:… more
- The Cigna Group (Philadelphia, PA)
- …and works as part of the team to manage heath care cost and utilization Provider Support + Completes telephonic nursing assessments including social determinants ... health care advice/education regarding health promotion, illness prevention, and management of disease utilizing nursing assessment data, patient, family, and… more