- Humana (Dover, DE)
- …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
- Veterans Affairs, Veterans Health Administration (Coatesville, PA)
- …possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... Summary The Nurse Community Care (CC) Coordinator Registered Nurse...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
- Insight Global (Philadelphia, PA)
- …License or Active LPN License 2-3 years of clinical experience ( Utilization management or utilization review ) Strong computer skills Ability to ... of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer...Previous HEDIS review experience or experience with Utilization Review , Quality, Medical Record auditing Bachelors… 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...and home-based visits and telephonic support on a care management or case management basis appropriate to… more
- The Cigna Group (Philadelphia, PA)
- …about their care options and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all requirements 5. Explain test ... education including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or… more
- Fresenius Medical Center (Dover, DE)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Wilmington, DE)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- ChenMed (Philadelphia, PA)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... great people to join our team. The Acute Care Nurse is responsible for achieving positive patient outcomes, managing...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- GetWellNetwork, Inc. (Philadelphia, PA)
- …Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to ... Well's Client Success Manager is responsible for effective product utilization and successful outcomes for the Get Well system...of the Get Well system by conducting quarterly account review meetings pertaining to account roadmap; conduct nurse… more
- Penn Medicine (Philadelphia, PA)
- …skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team, and physician ... fearful you will miss patient contact? If so, our nurse case manager role at Penn Medicine is the...community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management… more
- Evolent (Dover, DE)
- …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
- 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 enhance hospital system and tenant relationships. Manage the real estate management staff and overall real estate operations to support property investment plans… more
- Evolent (Dover, DE)
- …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
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... community resourcesParticipates and drives accountability in daily interdisciplinary meetings Utilization Management :Adheres to guidelines to satisfy 3rd party… more
- Intermountain Health (Dover, DE)
- …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
- Trinity Health (Wilmington, DE)
- …complex problems in the areas of census verification, bed assignment and utilization review . + Ensures compliance with hospital departmental policies and ... about the hospital's bed availability + Ensure proper bed utilization and management throughout the hospital. +...acute care setting required + Previous Supervisor or Charge Nurse experience required + Must possess sound computer literacy.… more
- Virtua Health (Marlton, NJ)
- …for the assessment, planning, implementation, monitoring and evaluation of case management services through the appropriate utilization of resources. Application ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Virtua Health (Marlton, NJ)
- …and Palliative Care and Hospice Team members to assure that clinical protocols, utilization review , case management , quality assurance, and compliance ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... DME, placements, hospice, community resources, transportationQuality data collection and risk management referralWorks with patient and family to assure provision of… more
- Penn Medicine (Bala Cynwyd, PA)
- …support clinical operations and the provision of care delivery. He/She will review clinical documentation and participate in other quality and regulatory activates. ... team that includes the following: o Clinical staff case management & direct clinical care o Regulatory compliance o... & direct clinical care o Regulatory compliance o Review of new product and services o Clinical development… more