- Trinity Health (Philadelphia, PA)
- …**Description:** Nazareth Hospital, a member of Trinity Health Mid-Atlantic, is seeking experienced Utilization Management RN to join the Case Management ... Under the general supervision of the Manager of Utilization Management , the Utilization RN assists physicians and the interdisciplinary team in… more
- CVS Health (Trenton, NJ)
- …convenient and affordable. **Position Summary** This is a full -time remote Utilization Management Nurse Consultant opportunity. Utilization ... include weekends and holidays and evening rotations. As a Utilization Management Nurse Consultant, you...of residence + 3+ years of experience as a Registered Nurse + 1+ years of clinical… more
- Geisinger (Philadelphia, PA)
- …and License(s) Basic Life Support Certification - Default Issuing Body; Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE & ... Philadelphia area to join Geisinger as an In-House Travel RN ! 12-week assignments are available in Adult Med Surg,...*some specialties may experience a wait list at times Full -time hours Market leading all-inclusive rates Travel allowances for… more
- Fresenius Medical Center (Philadelphia, PA)
- …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
- 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 ... of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer...diverse and inclusive environments where people can bring their full , authentic selves to work every day. We are… more
- AmeriHealth Caritas (Newtown Square, PA)
- …about us at www.amerihealthcaritas.com . **Responsibilities:** + Direct activities of the Utilization Management staff. Oversee staff performance with regard to ... and transportation services. + Ensure effective daily operation of the Utilization Management Department utilizing all applicable statutory provisions, contracts… more
- Humana (Trenton, NJ)
- …part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... to prevent and detect fraud, waste, and abuse. The RN Compliance Nurse 2, Quality Assurance Audit...care, skilled and/or rehabilitation clinical setting + Experience with utilization management , pre-service denials and/or quality assurance… more
- CVS Health (Trenton, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... responsible for; care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong...home health or ambulatory care + Active and Unrestricted RN license in NJ + 50 to 75% travel… more
- Penn Medicine (Philadelphia, PA)
- …overtime utilization + Assists with the implementation of change management strategies within the practice in alignment with department, entity/Penn Medicine ... Penn Medicine Washington Square- 800 Walnut St **Hours:** Per Departmental Needs - Full Time Summary: + The Clinical Coordinator will be responsible for overseeing… more
- CVS Health (Trenton, NJ)
- …state of New Jersey as one of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse ( RN ), Clinical Nurse Specialist (CNS), Licensed ... the plan and works across various departments including Care Management , Utilization Management , Quality ...confidence **Education** Master's degree in behavioral health field; or Registered Nurse (BSN preferred) ers **Pay Range**… more
- Humana (Trenton, NJ)
- …Training programs may include, but not be limited to, Care Management , Utilization Management , and/or Compliance. RN licensure is required at all ... Nursing with a focus on nursing education. + Licensed Registered Nurse ( RN ) in the...a good faith estimate of starting base pay for full time (40 hours per week) employment at the… more
- Penn Medicine (Philadelphia, PA)
- …patient care. Nursing Clinical Coordinator also works collaboratively with the Bed Management RN and the Nursing Administrative Coordinator. Responsibilities: + ... With guidance from the Nursing Administrative Coordinator, he/she assumes full responsibility for staffing functions from 1600 - 0700...satisfaction. Credentials: + Basic Cardiac Life Support (Required) + Registered Nurse - PA (Required) + 3… more
- Trinity Health (Philadelphia, PA)
- …or BA in Nursing + PA RN License + Three (3) years of utilization management or case management experience, including emphasis on discharge planning. + ... **Employment Type:** Full time **Shift:** 12 Hour Day Shift **Description:**...a member of Trinity Health Mid-Atlantic, is seeking experienced RN Care Manager to join our ED team! **Schedule:**… more
- CVS Health (Trenton, NJ)
- …visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the member experiences a ... care more personal, convenient and affordable. This is a full -time telework position. The hours for this role are...impact on our members, who are enrolled in Care Management and present with a wide range of complex… more
- AmeriHealth Caritas (Newtown Square, PA)
- …complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable. + Monitor appropriate utilization and ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Penn Medicine (Radnor, PA)
- …of Pennsylvania (CPUP)** **Department: Internal Medicine** **Location: Radnor, PA** **Hours: Full -Time** Summary: + This position typically reports to the Department ... Directors to optimize workflows and drive efficient and effective utilization of PennChart and MyPennMedicine by clinical staff. +...staff. + Serves on Appropriate Departmental Committees. Credentials: + RN or PA-C or CRNP or CNM (Required) +… more
- Penn Medicine (Berwyn, PA)
- …Medicine Valley Forge - 1001 Chesterbrook Blvd **Hours:** Per Departmental Needs - Full Time Summary: + Under the direction of the Practice Leadership, the Clinical ... knowledge by participating in nursing and medical conferences and activities. Department Management + Manages and supervises the delivery of care by practice-based… more