- Cognizant (Harrisburg, PA)
- …you need to have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Harrisburg, PA)
- …we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Harrisburg, PA)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- WellSpan Health (Gettysburg, PA)
- …Degree Required **Work Experience:** + 1 year Relevant experience. Required **Licenses:** + Licensed Registered Nurse Upon Hire Required or + Registered ... the patient's diagnosis, corporate policy and procedures and the Nurse Practice Act. Carries primary care management functions for...of visits, phone calls and conferences in the patient's clinical record on a timely basis and legible manner.… more
- Humana (Harrisburg, PA)
- **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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- Evolent (Harrisburg, PA)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- UPMC (Harrisburg, PA)
- …the most specialized and rewarding areas of pediatric medicine. Purpose: The Programmatic Nurse Specialist, a professional registered nurse , has the ... In collaboration with the health care team, the Programmatic Nurse Specialist applies expert clinical knowledge and...Cardiopulmonary Resuscitation (CPR) + Neonatal Resuscitation Program (NRP) + Registered Nurse (RN) + Act 31 Child… more
- UPMC (Carlisle, PA)
- …dependents (plus discounts for UPMC employees including no cost RN-BSN/MSN options!) The Professional Staff Nurse OR is a Registered Nurse and a member of ... discretion of the BU. + Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Registered Nurse (RN) OR Temporary Practice Permit (TPP) + Act 31 Child… more
- UPMC (Carlisle, PA)
- The Senior Professional Staff Nurse II is a Registered Nurse , a member of the care delivery team, and responsible for seeking opportunities to assist in ... Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Pediatric Advanced Life Support (PALS) + Registered Nurse (RN) + Act 31 Child Abuse Reporting with renewal… more
- WellSpan Health (Gettysburg, PA)
- …or + Licensed Practical Nurse Multi State License Upon Hire Required or + Licensed Registered Nurse Upon Hire Required or + Registered Nurse Multi ... planning and implementation of patient care based upon sound nursing judgment, clinical preparation, knowledge, skills and experience. Nursing care is provided in… more
- UPMC (Mechanicsburg, PA)
- …discretion of the BU. + Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) + Registered Nurse (RN) OR Temporary Practice Permit (TPP) + Act 31 Child ... and Clearances: UPMC approved national certification preferred. Current licensure as a Registered Professional Nurse either in the state where the facility… more
- UPMC (Mechanicsburg, PA)
- …licensure as a Registered Professional Nurse in practicing state. + Registered Nurse (RN) *Current licensure either in the state where the facility is ... patient care, creating a healthy workplace for staff, and overseeing clinical , and administrative/business functions. The Unit Director is responsible for… more
- UPMC (Harrisburg, PA)
- …and mentoring as appropriate. 1) Diploma or associate degree in nursing and active Registered Nurse license. At least one year of experience in discharge ... a focus on an optimal discharge plan with timely utilization of hospital resources. This optimal discharge plan reviews...OR Other Healthcare Professional Licenses for Discharge Planning OR Registered Nurse (RN) + Act 31 Child… more
- Highmark Health (Harrisburg, PA)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- CVS Health (Harrisburg, PA)
- …conditions. + **Diabetes education experience** is required. + Current, unrestricted ** Registered Nurse (RN) license** ; multi-state licensure preferred. + ... health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care,… more
- Select Medical (Hummelstown, PA)
- …of acute transfers and other CQI indicators. **Qualifications** **Minimum Qualifications** + Registered Nurse with valid state license. Legacy employees may ... the design and compliance of quality processes/activities in the areas of clinical /medical staff PI for all applicable clinical /medical TJC /CARF/DOH standards.… more
- Select Medical (Harrisburg, PA)
- …Current Licensure in a clinical discipline per state guidelines required. ( Registered Nurse or Social Work (SW) preferred) **Preferred Qualifications** + ... time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and appropriate… more
- Select Medical (Hummelstown, PA)
- …Current Licensure in a clinical discipline per state guidelines required. ( Registered Nurse or Social Work (SW) preferred) **Preferred Qualifications** + ... time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and appropriate… more