- R1 RCM (Pittsburgh, PA)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse ** , you will help our ... excelling in this position. **Here's what you will experience working as a Utilization Review Nurse :** + Perform initial admission and continued stay reviews… more
- UPMC (Pittsburgh, PA)
- Are you an experienced nurse with an extensive background in case management? Are you looking for an opportunity to use your nursing assessment skills without ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
- UPMC (Blawnox, PA)
- …promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, ... and other health plan and system departments as appropriate. + Review member's current medication profile; identify issues related to medication adherence,… more
- UPMC (Pittsburgh, PA)
- Are you an experienced nurse with a background in case management? Are you interested in the opportunity to work from home? UPMC Health Plan is looking for you! We ... the Insurance Services Division. **Responsibilities:** + Present complex members for review by the interdisciplinary team summarizing clinical and social history,… more
- UPMC (Pittsburgh, PA)
- …the Insurance Services Division. **Responsibilities:** + Present complex members for review by the interdisciplinary team summarizing clinical and social history, ... healthcare resource utilization , case management interventions. Update the plan of care...case management interventions. Update the plan of care following review and communicate recommendations to the member and providers.… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. + Adheres to the policies, procedures, rules,… more
- Highmark Health (Pittsburgh, PA)
- …+ Performs as the clinical subject matter expert for clinical, quality, care, utilization , high cost claim and population health management as the part of the ... and accounts after customer discussions.Participate in ad-hoc and annual clinical review meetings as needed to provide clinical, health and wellness perspective;… more