Utilization Management Nurse
3 weeks ago
Why Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential. While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ. Perks of JHP and why you will love it here: * Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing * Flextime and Work-at-Home Options * Benefits & Wellness Program including generous Time Off * Impact on the communities we service We are seeking a talented and enthusiastic Utilization Management Nurse to join our team The Utilization Management Nurse is responsible assure cost effective, quality utilization management in the acute level of care setting for the pediatric or adult population in the post-acute inpatient setting (i.e.,SNF/Rehab). Also, responsible to review clinical information provided by facilities and communicates UM determinations maintaining timeliness. As the Utilization Management Nurse, your daily duties may include: * Review and track emergency admissions to identify appropriate level of care for acute and post-acute inpatient services. * Perform concurrent review and/or admission review on all hospital admissions using InterQual criteria guidelines. * Track assigned cases for timely reviews/updates and decisions as reflected in case documentation. * Request and review medical records to identify appropriate acute care days and approve or refer questionable days to the medical director for decision. * Function as a liaison between providers, members and interdepartmentally. * Serve as resource for physicians, PCPs, Utilization Review departments and all medical providers. * Identify trends that impact on utilization at hospitals during the review process and help resolve them. * Maintain departmental and regulatory timeframes for utilization decisions. * Contributes to the development and enhancement of documentation, tracking tools and process flows * Maintains collaborative and effective cross- functional training within the Utilization Management Department Utilization management perform after hour's on-call coverage. * Participates in relevant work groups and provide deliverables as necessary * Successful and timely completion of assignments in accordance with departmental and Company operational objectives and seeks feedback on performance. Ensures that assignments are scheduled and completed in an accurate and timely manner. * Maintains detailed knowledge of the status of all assignments and routinely updates the manager, as appropriate * Responsible to for after hour on call shifts as needed * Performs all other duties as assigned Qualifications * Licensed Registered Nurse, must have an active license to practice professional nursing in the Commonwealth of Pennsylvania * 2 years medical/surgical, utilization review and emergency room experience. * BSN preferred. Skills, We Value: * Must present polished professional image. * Thorough understanding of managed care systems and utilization review criteria * Recent experience in a hospital, insurance company, or independent review company in utilization, quality review or case management * Knowledge of health insurance including Medicare, Medicaid and managed care * Ability to work and communicate effectively with co-workers, members and providers at the owner institutions. * Must be organized, detailed oriented, and capable of handling multiple issues. * Excellent telephone and verbal/written communication skills. * Proficient use of Microsoft Office suite (Word, PowerPoint, Excel) required. Other details * Pay Type Salary Apply Now * Erie, PA, USA * Harrisburg, PA, USA * Philadelphia, PA, USA * Pittsburgh, PA, USA * Scranton, PA, USA
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Utilization Management Nurse
4 weeks ago
Philadelphia, PA, United States Health Partners Plans Full timeUtilization Management Nurse Why Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone...
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Utilization Management RN
2 weeks ago
Philadelphia, PA, United States Thomas Jefferson University Hospital Full timeUtilization Management RNResponsibilities Join the mission of Improving Lives as a Utilization Management RN at Jefferson Health. With more than 42,000 employees, we're the second largest employer in Philadelphia and the largest health system in the Philadelphia region. And our work to improve lives is never done. Utilization Management RNs are responsible...
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Utilization Management Nurse
4 weeks ago
Philadelphia, United States Health Partners Plans Full timeUtilization Management NurseWhy Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone...
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Utilization Management Nurse
3 weeks ago
Philadelphia, United States Health Partners Plans Full timeUtilization Management NurseWhy Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone...
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Utilization Management Nurse
3 days ago
Philadelphia, Pennsylvania, United States Insight Global Full timeJob Title: Utilization Management Nurse (RN) at a Healthcare Insurance CompanyLocation: Philadelphia, PADuration: 6-month contract with potential for permanent hireSchedule: Onsite Monday to Friday, either 8 AM to 5 PM or 9 AM to 6 PMHourly Pay: $40-44 per hourInterview Process: Two roundsRequirements:Active NJ or PA RN licenseMinimum 2 years of experience...
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Utilization Management Nurse
4 weeks ago
Philadelphia, United States Insight Global Full timeLocation: Philadelphia PA 19103Duration: 6 month contract to hireSchedule: Fully Onsite Mon-Fri, 8AM-5PM or 9AM-6PMHourly Pay: $40-45/hrInterview Process: 2 rounds Must HavesActive NJ or PA RN license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or Medicare/Medicaid Experience/knowledge of NCQA, CMS...
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Utilization Management Nurse
3 weeks ago
Philadelphia, United States Insight Global Full timeLocation: Philadelphia PA 19103Duration: 6 month contract to hireSchedule: Fully Onsite Mon-Fri, 8AM-5PM or 9AM-6PMHourly Pay: $40-45/hrInterview Process: 2 rounds Must HavesActive NJ or PA RN license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or Medicare/Medicaid Experience/knowledge of NCQA, CMS...
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Utilization Management Nurse
4 weeks ago
Philadelphia, United States Insight Global Full timeLocation: Philadelphia PA 19103Duration: 6 month contract to hireSchedule: Fully Onsite Mon-Fri, 8AM-5PM or 9AM-6PMHourly Pay: $40-45/hrInterview Process: 2 rounds Must HavesActive NJ or PA RN license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or Medicare/Medicaid Experience/knowledge of NCQA, CMS...
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Utilization Management Nurse
3 weeks ago
Philadelphia, United States Insight Global Full timeLocation: Philadelphia PA 19103Duration: 6 month contract to hireSchedule: Fully Onsite Mon-Fri, 8AM-5PM or 9AM-6PMHourly Pay: $40-45/hrInterview Process: 2 rounds Must HavesActive NJ or PA RN license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or Medicare/Medicaid Experience/knowledge of NCQA, CMS...
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Utilization Management Nurse
3 weeks ago
Philadelphia, United States Insight Global Full timeLocation: Philadelphia PA 19103Duration: 6 month contract to hireSchedule: Fully Onsite Mon-Fri, 8AM-5PM or 9AM-6PMHourly Pay: $40-45/hrInterview Process: 2 rounds Must HavesActive NJ or PA RN license 2+ years of experience working in Utilization Review or Utilization Management with commercial payers or Medicare/Medicaid Experience/knowledge of NCQA, CMS...
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Utilization Management Nurse
3 weeks ago
Philadelphia, United States Insight Global Full timeLocation: Philadelphia PA 19103Duration: 6 month contract to hireSchedule: Fully Onsite Mon-Fri, 8AM-5PM or 9AM-6PMHourly Pay: $40-44/hrInterview Process: 2 roundsMust HavesActive NJ or PA RN license2+ years of experience working in Utilization Management with commercial payers or Medicare/MedicaidExperience/knowledge of NCQA, CMS and InterQualPlussesBSNDay...
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Utilization Review Nurse
2 months ago
Meadowbrook, PA, United States Holy Redeemer Hospital and Medical Center Full timeUtilization Review NursePer Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care...
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Utilization Review Nurse
3 weeks ago
Meadowbrook, PA, United States Holy Redeemer Hospital and Medical Center Full timeUtilization Review NursePer Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care...
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Registered Nurse-Home Health QAPI
2 days ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRegistered Nurse-Home Health QAPIVNA/PHMC is proud to be a leader in public health. PHMC requires that all employees are fully vaccinated with the Covid-19 vaccine before the first day of employment. The Visiting Nurse Association of Greater Philadelphia is a leading provider of home health, hospice, and palliative care services in Philadelphia and...
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Utilization Management RN
2 weeks ago
Philadelphia, United States Thomas Jefferson University Hospital Full timeUtilization Management RNResponsibilities Join the mission of Improving Lives as a Utilization Management RN at Jefferson Health. With more than 42,000 employees, we're the second largest employer in Philadelphia and the largest health system in the Philadelphia region. And our work to improve lives is never done. Utilization Management RNs are responsible...
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Respite Nurse Manager
4 weeks ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRespite Nurse Manager PHMC is proud to be a leader in public health. PHMC requires all employees to be fully vaccinated for COVID-19 before the first day of employment. We will offer the vaccination at no cost via our Health Centers. POSITION SUMMARY: The Nurse Manager is a registered nurse who is responsible for coordinating services at the medical...
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Respite Nurse Manager
4 weeks ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRespite Nurse ManagerPHMC is proud to be a leader in public health. PHMC requires all employees to be fully vaccinated for COVID-19 before the first day of employment. We will offer the vaccination at no cost via our Health Centers. POSITION SUMMARY: The Nurse Manager is a registered nurse who is responsible for coordinating services at the medical respite...
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Respite Nurse Manager
3 weeks ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRespite Nurse ManagerPHMC is proud to be a leader in public health. PHMC requires all employees to be fully vaccinated for COVID-19 before the first day of employment. We will offer the vaccination at no cost via our Health Centers. POSITION SUMMARY: The Nurse Manager is a registered nurse who is responsible for coordinating services at the medical respite...
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Utilization Management RN
3 days ago
Philadelphia, Pennsylvania, United States Thomas Jefferson University Hospital Full timeUtilization Management RNResponsibilitiesJoin the mission of Improving Lives as a Utilization Management RN at Jefferson Health. With more than 42,000 employees, we're the second largest employer in Philadelphia and the largest health system in the Philadelphia region. And our work to improve lives is never done.Utilization Management RNs are responsible for...
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Travel Nurse RN
3 weeks ago
Philadelphia, PA, United States Medical Solutions Full timeMedical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Philadelphia, Pennsylvania.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hours, daysEmployment Type: Travel We’re seeking talented healthcare professionals whose...
