• Utilization Management Review

    Humana (Harrisburg, PA)
    …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (01/20/25)
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  • Utilization Management Specialist…

    Penn State Health (Hershey, PA)
    …for maintaining compliance with the CMS Conditions of Participation for Utilization Management . **MINIMUM QUALIFICATIONS:** + Bachelors Degree in Nursing ... and family medical or genetic information._ **Union:** SEIU Healthcare Pennsylvania **Position** Utilization Management Specialist - DAY SHIFT - Utilization more
    Penn State Health (01/01/25)
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  • R&E Nurse - Med Care Services- Advanced

    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 ... 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
    Health Advocates Network (11/16/24)
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  • Registered Nurse (RN), Albright College,…

    Lancaster General Health (Lancaster, PA)
    …as defined by the American Nurses Association standards of nursing practice. The Clinical Nurse 2 Colleague is an RN that practices as a full partner on the ... must be able to working closely with college to review compliance health forms while maintaining HIPAA. Position has...into full functioning office with onsite provider. The Clinical Nurse 2 Colleague possesses the knowledge, skills and the… more
    Lancaster General Health (12/07/24)
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  • Registered Nurse (RN), Ortho OR, Part-Time…

    Lancaster General Health (Lancaster, PA)
    …as defined by the American Nurses Association standards of nursing practice. The Clinical Nurse 1 New to Practice/Apprentice is a newly licensed new to practice RN ... safe practice within the organizational professional practice model. The Clinical Nurse 1 New to Practice/Apprentice seeks guidance to integrate concepts, knowledge,… more
    Lancaster General Health (01/23/25)
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  • Registered Nurse (RN), Women and Babies…

    Penn Medicine (Lancaster, PA)
    …as defined by the American Nurses Association standards of nursing practice. The Clinical Nurse 2 Colleague is an RN that practices as a full partner on the ... demonstrates safe practice within the organizational professional practice model. The Clinical Nurse 2 Colleague possesses the knowledge, skills and the attitude to… more
    Penn Medicine (01/16/25)
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  • Registered Nurse (RN), Main Operating Room,…

    Penn Medicine (Lancaster, PA)
    …as defined by the American Nurses Association standards of nursing practice. The Clinical Nurse 1 New to Practice/Apprentice is a newly licensed new to practice RN ... safe practice within the organizational professional practice model. The Clinical Nurse 1 New to Practice/Apprentice seeks guidance to integrate concepts, knowledge,… more
    Penn Medicine (01/15/25)
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  • Registered Nurse Medical/Cardiac Telemetry…

    Lancaster General Health (Lancaster, PA)
    …as defined by the American Nurses Association standards of nursing practice. The Clinical Nurse 2 Colleague is an RN that practices as a full partner on the ... demonstrates safe practice within the organizational professional practice model. The Clinical Nurse 2 Colleague possesses the knowledge, skills and the attitude to… more
    Lancaster General Health (01/04/25)
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  • Care Nurse Coordinator RN - Extended Acute…

    WellSpan Health (Mount Gretna, PA)
    …of alternative treatment settings to provide appropriate care. + Coordinate with Case Management as indicated. + Participates in the review of policy and ... Care Nurse Coordinator RN - Extended Acute Adult Psychiatric...assigned patients using Motivational Interviewing strategies in the active management of their health by encouraging participation in their… more
    WellSpan Health (11/26/24)
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  • Registered Nurse (RN) 4L Ortho/Total Joints…

    Lancaster General Health (Lancaster, PA)
    …and that established outcomes are achieved through availability and appropriated utilization of human, material and financial resources. + Educates patients about ... improvement activities with an emphasis on increasing continuity in the nurse to patient relationship, minimizing rework and redundancies; constantly seeks ways… more
    Lancaster General Health (10/30/24)
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  • Licensed Practical Nurse - Outpatient…

    WellSpan Health (Lebanon, PA)
    …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... Licensed Practical Nurse - Outpatient Orthopedics Lebanon - Days Location:...patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results… more
    WellSpan Health (01/18/25)
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  • Licensed Practical Nurse - Internal…

    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 ... Licensed Practical Nurse - Internal Medicine Apple Hill York Location:...patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results… more
    WellSpan Health (01/12/25)
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  • Licensed Practical Nurse - Ephrata…

    WellSpan Health (Ephrata, PA)
    …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... Licensed Practical Nurse - Ephrata Digestive Health Location: WellSpan Medical...patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results… more
    WellSpan Health (01/22/25)
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  • Registered Office Nurse (RN), The Heart…

    Lancaster General Health (Lancaster, PA)
    …physiologic, psychological, and cognitive functions, through patient/provider office visits, nurse visits, and telephone triage. Collaborates with Physician and ... physiologic, psychological, and cognitive functions, through patient/provider office visits, nurse visits, and telephone triage. Collects and manages comprehensive… more
    Lancaster General Health (01/22/25)
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  • Registered Office Nurse (RN), Lancaster…

    Penn Medicine (Lancaster, PA)
    …physiologic, psychological, and cognitive functions, through patient/provider office visits, nurse visits, and telephone triage. Collaborates with Physician and ... physiologic, psychological, and cognitive functions, through patient/provider office visits, nurse visits, and telephone triage. Collects and manages comprehensive… more
    Penn Medicine (01/16/25)
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  • Manager of Case Management RN - Day

    WellSpan Health (Lebanon, PA)
    …and resolve barriers for staff. Common Expectations: + Demonstrates knowledge of case management , utilization review and population health. Assesses and ... nurses and administrative staff, focused on care progression, emergency room case management support, readmission, and utilization management . Working in… more
    WellSpan Health (12/18/24)
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  • Physician Advisor

    WellSpan Health (York, PA)
    …York, PA Schedule: PRN/Per Diem General Summary Provides direct supervision of case management and utilization review activities performed by the WellSpan ... staff. Duties and Responsibilities Essential Functions: + Renders utilization management determination in accordance with State...of care and verify need for peer to peer review -discuss with the CM nurse and/or attending… more
    WellSpan Health (01/17/25)
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  • Professional Care Manager-Care Management

    UPMC (Harrisburg, PA)
    …(CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and ... all Avoidable Days in CANOPY system. + Performs clinical review on admission and/or continued stay using InterQual criteria...required with 4-6 weeks of hire. UPMC approved Care Management certification preferred. + Registered Nurse (RN)… more
    UPMC (12/07/24)
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  • Sr. Professional Care Manager Outcomes…

    UPMC (Mechanicsburg, PA)
    …(CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and ... of Completion required within 4-6 weeks of hire UPMC approved Care Management certification preferred + Registered Nurse (RN) *Current licensure either… more
    UPMC (12/07/24)
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  • Chief Clinical Officer

    Evolent (Harrisburg, PA)
    …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
    Evolent (12/21/24)
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