- Highmark Health (Harrisburg, PA)
- …etc. (30%) + Maintains a working knowledge of care management, utilization review changes, authorization changes, contract changes, regulatory requirements, ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:**...as an educational resource to all AHN staff regarding utilization review practice and governmental/commercial payer guidelines.(5%)… more
- Highmark Health (Pittsburgh, PA)
- …with operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims, coordination of benefits ... **Company :** Allegheny Health Network **Job Description :** REPOSTED: 20241206...benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. + Adheres to the policies, procedures, rules,… more
- UPMC (Pittsburgh, PA)
- …Five years of experience in clinical, care coordination, and/or case management required. + Registered Nurse ( RN ) or Social Services Licensure (LSW, LCSW, ... the Special Needs Plan line of business within the Allegheny County Care Management Team. The team is looking...a clinical setting and case management nursing required. + Registered Nurse ( RN ) + .Meet… more
- Highmark Health (Wexford, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory… more
- Highmark Health (Erie, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... **Company :** Allegheny Health Network **Job Description :** **St. Vincent...engages patients/caregivers in their healthcare, and supports effective resource utilization . Serves as key team members in the management… more