- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Harrisburg, PA)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… more
- CVS Health (Harrisburg, PA)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... Nursing Licenses as business needs require. * **Preferred Qualifications** - Utilization Management experience preferred **Education** Associates Degree BSN… more
- CVS Health (Harrisburg, PA)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience Must have active current and ... 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 ... heart, each and every day. **Position Summary** + Utilizes clinical experience and skills in a collaborative process to...Qualifications** - 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN… more
- CVS Health (Harrisburg, PA)
- …and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with ... are worked on the Saturday and Sunday. + Utilizes clinical experience and skills in a collaborative process to...to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal… more
- CenterWell (Harrisburg, PA)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CVS Health (Harrisburg, PA)
- …a hospital setting required for either BH or RN -1+ years of utilization review/ utilization management required (ie concurrent review, pre-certifications) ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- Centene Corporation (Harrisburg, PA)
- …IS REMOTE/WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS BEHAVIORAL HEALTH UTILIZATION MANAGEMENT .** **APPLICANTS MUST EITHER HOLD AN ACTIVE PA ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Centene Corporation (Harrisburg, PA)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, ... Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with… more
- Evolent (Harrisburg, PA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Geisinger (Danville, PA)
- Job Summary Geisinger is proud to offer a full time Clinical Team Coordinator up to $24,000 hiring incentive for eligible candidates! Unit Location: GP2 Job Duties ... proper documentation and follow-through. Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying… more
- Fresenius Medical Center (Dallas, PA)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member… more
- BAYADA Home Health Care (Blue Bell, PA)
- …in Senior Living **_._** Are you a solutions-oriented, team-focused **Registered Nurse , Licensed Practical Nurse or Therapist (Physical Therapist, Occupational ... create alignment to common goals across multiple levels of management ? Would you like to be viewed as a...members to deliver on our differentiated offerings. Through the utilization of outcome driven data analytics, this role will… more
- WellSpan Health (Waynesboro, PA)
- …+ 2 years Recent acute care experience. Required + Utilization management , care management , or clinical nursing specialty. Preferred **Licenses:** ... **General Summary** Performs a variety of duties and applies utilization and care management techniques to determine... Nurse Upon Hire Required or + Registered Nurse Multi State License Upon Hire Required and +… more
- Fresenius Medical Center (Pittsburgh, PA)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- WellSpan Health (York, PA)
- …years of RN experience required + Field of Experience in Utilization Management , Case Management , or Clinical Nursing Specialty. Preferred **Licenses:** ... **Essential Functions:** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for... Nurse Upon Hire Required or + Registered Nurse Multi State License Upon Hire Required and +… more
- WellSpan Health (Lebanon, PA)
- …Acute Care experience. Required + Field of experience in Utilization Management , Case Management , or Clinical Nursing Specialty. Preferred **Licenses:** ... and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for... Nurse Upon Hire Required or + Registered Nurse Multi State License Upon Hire Required and +… more
- WellSpan Health (Chambersburg, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License… more
- 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 ... + 1 year Clinical nursing experience. Required **Licenses:** + Licensed Practical Nurse Upon Hire Required or + Licensed Practical Nurse Multi State License… more