- 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
- 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
- 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
- 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 ... Licensed Practical Nurse (Outpatient) - Onsite Clinics Gettysburg Location: WellSpan...patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results… more
- 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 (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
- 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 (Harrisburg, PA)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Intermountain Health (Harrisburg, PA)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more
- BAYADA Home Health Care (Mechanicsburg, PA)
- …seeking a full-time **Physical Therapist (PT), Occupational Therapist (OT), or Registered Nurse (RN)** to fill the position of **Rehab Manager** in our Harrisburg, ... and procedures. Rehab Managers are also accountable for internal case management , field staff evaluation and development. The successful Physical Therapist,… more