- Insight Global (Philadelphia, PA)
- …License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer...Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors… more
- Fresenius Medical Center (Philadelphia, PA)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Highmark Health (Trenton, NJ)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Humana (Trenton, NJ)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- The Cigna Group (Philadelphia, PA)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for… more
- Humana (Trenton, NJ)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- ChenMed (Philadelphia, PA)
- …RN with bachelor's degree in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... great people to join our team. The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...experience required. + A minimum of 1 year of utilization review and/or case management ,… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- ChenMed (Philadelphia, PA)
- …with bachelor's degree in home in a related clinical field preferred. + A valid, active Registered Nurse ( RN ) license in State of employment required. + A ... great people to join our team. The Community Care RN ( Nurse Case Manager) is responsible for...with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ;… more
- RWJBarnabas Health (Hamilton, NJ)
- …of Microsoft applications ex. Word ,Excel Preferred: + Utilization review and discharge planning experience + Case Management certification Certifications ... Inpatients to determine appropriateness of continued stay, care planning, utilization management and discharge planning. Required: +...and Licenses Required: + Current license as a registered Nurse in the State of NJ… more
- Penn Medicine (Philadelphia, PA)
- …assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet) Credentials: + Registered Nurse - PA (Required) + PA RN Licensure required. Education or ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management … more
- Guardian Life (Trenton, NJ)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Sedgwick (Trenton, NJ)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
- Penn Medicine (Philadelphia, PA)
- …(Outlook, Canopy, CERME, ECIN, shared drive, Internet) + Credentials: Registered Nurse - PA (Required) PA RN Licensure required. Education or Equivalent ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the...being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team,… more
- Spectrum Health Services (Philadelphia, PA)
- …care team, assesses patients for risk of adverse health outcomes, inappropriate utilization , and monitors the impact of care management interventions. Essential ... specialty care practices, health plan staff, and others, the Nurse Care Manager identifies and proactively manages the needs...and home-based visits and telephonic support on a care management or case management basis appropriate to… more