- AmeriHealth Caritas (Philadelphia, PA)
- …Registered Nurse ** Location: Philadelphia, PA Primary Job Function: Medical Management ID**: 34518 **Job Brief** Current PA RN . Bachelor's degree ... 3+ yrs clinical practice experience working with medically fragile pediatric patients. Utilization Management experience preferred. Your career starts now. We… more
- Insight Global (Philadelphia, PA)
- …Active RN License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review) Strong computer skills Ability to ... looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY ...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license… more
- Prime Therapeutics (Trenton, NJ)
- …oversight for this program is provided by the Manager, Patient Programs. **Responsibilities** + Registered Nurse ( RN ). + 5 years of post-degree clinical ... experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan...- Preferred: Bachelors - Nursing **Certifications** Certifications - Required: RN - Registered Nurse , State… more
- Elevance Health (Wilmington, DE)
- ** RN Hospital Bill Audit/Appeal Lead** **Supports the Carelon Payment Integrity line of business** _Location: This position will work a hybrid model ( remote and ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** RN Hospital Audit/Appeal Lead** is responsible for leading a team of… more
- CVS Health (Clementon, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... care more personal, convenient and affordable. **Position Summary** This is a remote case management opportunity with required travel throughout Camden County… more
- Penn Medicine (Philadelphia, PA)
- …involves on-site presence for the first 6 months with the possibility of remote work after the introductory period is complete._ Summary: Penn Medicine is looking ... end user productivity within the application. Ensure system changes follow change management procedures and protocols, create and maintain all documentation for all… more
- HealthEdge Software Inc (Trenton, NJ)
- …support people need, when and where they need it. We call it Digital Health Management . Our comprehensive suite of Digital Health Management solutions for care ... both clinical outcomes and the member experience. **What you bring:** + ** RN /NP/MSN** with **10+ years of health care experience** **required** ; ideally with… more
- Sage Therapeutics (Philadelphia, PA)
- …the role (ie, good documentation practices, standards, and procedures), and appropriate utilization and best practice sharing of available resources. + Interact with ... the ability to develop important relationships with key stakeholders, good conflict management and negotiation skills, and the ability to analyze complex issues to… more