- 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)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active ... Nursing Licenses as business needs require. * **Preferred Qualifications** - Utilization Management experience preferred **Education** Associates Degree BSN… more
- CVS Health (Harrisburg, PA)
- …1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience Must have active current ... additional Nursing Licenses as business needs require. * Preferred Qualifications - Utilization Management experience preferred - **Anticipated Weekly Hours** 40… more
- CVS Health (Harrisburg, PA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + UMNC meets set productivity and ... telephone and typing on the computer. + Work from home position:During work hours, Colleagues who are working from...Qualifications** - 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN… more
- CenterWell (Harrisburg, PA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… 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
- Centene Corporation (Harrisburg, PA)
- …FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS BEHAVIORAL HEALTH UTILIZATION MANAGEMENT .** **APPLICANTS MUST EITHER HOLD AN ACTIVE PA LICENSURE; ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… 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
- 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
- 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 ... Experience:** + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi… more
- Evolent (Harrisburg, PA)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… 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
- 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
- Humana (Harrisburg, PA)
- …others. **Essential Duties and Responsibilities:** + Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing ... inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare… more