- Trinity Health FirstChoice (Langhorne, PA)
- Trinity Health FirstChoice is seeking a travel nurse RN Case Management Manager for a travel nursing job in Langhorne, Pennsylvania.Job Description & ... and coordinates management of patient care including discharge planning and utilization needs. Supports ministry and system goals for capacity management … more
- St. Luke's University Health Network (Easton, PA)
- …, including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among ... patient's ability to pay for health care. The Registered Nurse or Social Worker Care Manager is responsible for...obtained within 3 years of hire, MSN and/or Case Management Certification preferred. TRAINING AND EXPERIENCE: Preference is for… 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...car for community travel. Other: + Experience in Care Management . + 2 -5 years of experience in… more
- Fresenius Medical Center (Upper Darby, PA)
- …FEATURES:** Modality: Incenter HD only. Days of Operation: Mon-Sun. 3 shift on MWF; 2 shifts TTS. \# of Stations: 19 Current Census: 86 **PURPOSE AND SCOPE:** ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Humana (Trenton, NJ)
- …ad hoc reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable ... caring community and help us put health first** The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 … more
- Prime Therapeutics (Trenton, NJ)
- …company achieving revenue goals and operational objectives. Responsible for executing utilization management programs on behalf of health plan/payor customers, ... clinical reviewer. + Practices and maintains the principles of utilization management by adhering to the company...cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization … more
- St. Luke's University Health Network (Bethlehem, PA)
- …, including but not limited to: RN care managers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among all ... continuum of care. The SW CM also works with the providers, registered nurse care managers, and multi-disciplinary care teams to facilitate the achievement of… more
- The Cigna Group (Philadelphia, PA)
- … and Coordination** 1. Participation in weekly care coordination with health plan case management as directed by market needs 2 . Referral Management Care ... in regard to their appointments, care, and overall health. 2 . Act as the liaison between the providers and...side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... resources + Participates and drives accountability in daily interdisciplinary meetings + Utilization Management : + Adheres to guidelines to satisfy 3rd party… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... resources Participates and drives accountability in daily interdisciplinary meetings + Utilization Management : Adheres to guidelines to satisfy 3rd party… more
- Trinity Health (Philadelphia, PA)
- …The Registered Nurse (RN) is responsible for providing oversight and management to the provision of service delivery to participants. Provide skilled nursing ... **Employment Type:** Part time **Shift:** **Description:** **Registered Nurse ** **Location: LIFE Broad Street, Philadelphia PA** **Status:** On-Call **Shift:**… more
- Fortive Corporation (Philadelphia, PA)
- …and local Integrated Delivery Networks (IDN), including the following: Supply Chain, Nurse Managers, Risk Management , and Sterile Processing, Materials ... Customer experiences. + Drive market share through existing customer utilization assessments and contending for new footprint expansion while...+ Minimum of 3 years of sales experience, or 2 years of medical sales experience, or 1 year… more
- Elevance Health (Wilmington, DE)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and procedures. + Investigates potential… more
- Virtua Health (Marlton, NJ)
- …over 2 ,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to ... triage. Clinician will promote delivery of quality care and efficient utilization of agency resources and interdisciplinary collaboration to establish a plan… more
- Spectrum Health Services (Philadelphia, PA)
- …for identifying said population via provider/external health facility referral, utilization management referral, disease registry reporting mechanisms and ... responsible for developing and facilitating the quality assurance, risk management , regulatory compliance, and operational performance improvement activities for all… more
- CVS Health (Blue Bell, PA)
- …collaborative position working proactively with the Aetna account team, Aetna's Care management teams, and key National and Enterprise account partners to support ... + Provide progressive consultative clinical insights based on analysis of clinical plan utilization and impact of member behavior on medical plan costs. + Recommend… more
- Wellpath (Thornton, PA)
- …the organization's Code of Conduct. + Demonstrates knowledge of risk management , clinical precautions, infection control, fall prevention, utilization of ... Graduation from an accredited School of Nursing Experience + 2 years of supervisory experience in an acute setting...+ Have and maintain current licensure as a Registered Nurse within the state of employment. + Obtain and… more
