Current jobs related to Utilization Management Nurse - Philadelphia PA United States - Health Partners Plans
-
Nurse Manager Utilization Review
2 weeks ago
Oswego, NY, United States Clinical Management Consultants Full timeAn award-winning acute care hospital located in central New York is currently searching for an experienced Nurse Manager Utilization Review to join their established healthcare system. This regional leading medical center is home to over 500 inpatient beds and provides a wide variety of awarded acute care services. This location offers exceptional emergency...
-
Nurse Manager Utilization Review
2 weeks ago
Westwood, NJ, United States Clinical Management Consultants Full timeA leading acute care hospital located in southeastern New York is now searching for an experienced Nurse Manager Utilization Review to join their award-winning healthcare team. This acute care facility was founded over one hundred years ago and today houses nearly 400 licensed beds and offers a wide variety of medical and surgical services. This...
-
Healthcare Utilization Management Nurse
3 weeks ago
Philadelphia, Pennsylvania, United States IntePros Full timeJob Title: Utilization Review NursePosition Type: Part-Time (Every other weekend - Saturday and Sunday, totaling 30 hours per month)Training Requirement: Candidates must be available M-F during typical business hours for a 4-week training period.Job Overview: The Utilization Review Nurse plays a crucial role in assessing patients' clinical situations by...
-
Nurse Director Utilization Review
2 weeks ago
Brockton, MA, United States Clinical Management Consultants Full timeA leading acute care hospital located in eastern Massachusetts is now searching for an experienced Nurse Director Utilization Review to join their award-winning healthcare team This not-for-profit acute care hospital is a respected healthcare facility with a long-standing history of providing a range of quality medical services to the local community....
-
Registered Nurse for Utilization Management
3 weeks ago
Philadelphia, Pennsylvania, United States Thomas Jefferson Univ Full timeReference #: Position Overview: The Utilization Management Registered Nurse (RN) is responsible for executing utilization management tasks, utilizing medical necessity guidelines to assess the suitable patient status. This role involves managing denial and appeal processes for inpatient hospital services. Cases will be escalated to the Physician Advisor in...
-
RN for Utilization Management
3 weeks ago
Philadelphia, Pennsylvania, United States Thomas Jefferson Univ Full timeReference #: Job Overview: The Utilization Management Registered Nurse is responsible for executing utilization management duties, utilizing medical necessity guidelines to assess the appropriate patient classification. This role includes managing denial and appeal processes for inpatient hospital services. Cases are referred to the Physician Advisor in...
-
RN for Utilization Management
3 weeks ago
Philadelphia, Pennsylvania, United States Thomas Jefferson Univ Full timeReference #: Job Overview: The Utilization Management Registered Nurse is responsible for executing utilization management tasks, utilizing medical necessity standards to assess suitable patient status. This role includes managing denial and appeal processes for inpatient hospital services and coordinating with the Physician Advisor according to departmental...
-
Nurse Manager Operating Room
3 weeks ago
Philadelphia, PA, United States Clinical Management Consultants Full timeA leading hospital is seeking a Nurse Manager Operating Room in the Greater Philadelphia metropolitan area. Become part of this nationally accredited hospital system that has served its community with outstanding quality care, delivered with compassion by caring professionals. This award winning hospital is known for its technologically advancements...
-
Utilization Management RN PRN
1 month ago
Philadelphia, United States Thomas Jefferson Univ Full timeReference #: 9303746 Job Summary Performs utilization management functions, applying medical necessity criteria to determine the appropriate patient status. Performs denial and appeal activities for inpatient hospital care. Refers cases to the Physician Advisor per departmental procedures. Works collaboratively with members of the Case Management Departments...
-
Pleasanton, CA, United States Clinical Management Consultants Full timeA prestigious 100+ patient bed hospital in Northern California is searching for a highly motivated and experienced Clinical Coordinator to join their dynamic healthcare team. This is an exceptional opportunity to make a significant impact on patient care and contribute to the growth and development of clinical services within the hospital. In this role, the...
-
Utilization Management RN PRN
3 weeks ago
Philadelphia, United States Thomas Jefferson University & Jefferson Health Full timeJob Summary Performs utilization management functions, applying medical necessity criteria to determine the appropriate patient status. Performs denial and appeal activities for inpatient hospital care. Refers cases to the Physician Advisor per departmental procedures. Works collaboratively with members of the Case Management Departments and healthcare team...
-
Utilization Management Director
2 weeks ago
, MI, United States Acadia Healthcare Full timeJob SummaryWe are seeking a highly skilled Director of Utilization Management to join our team at Acadia Healthcare. As a key member of our leadership team, you will be responsible for overseeing the utilization management program, ensuring compliance with regulations, and optimizing reimbursement for our facilities.Key ResponsibilitiesUtilization Review:...
-
Utilization Management Nurse Senior
7 days ago
, CA, United States Blue Shield of California Full timeAbout the RoleWe are seeking a highly skilled Utilization Management Nurse Senior to join our team at Blue Shield of California. As a key member of our Utilization Management team, you will play a critical role in ensuring our members receive high-quality, cost-effective care.Key ResponsibilitiesPerform prospective, concurrent, and retrospective utilization...
-
Utilization Management RN
4 months ago
Philadelphia, United States Open Systems Technologies Full timeJob DescriptionJob DescriptionContract to Hire position!Job Category Insurance Professional & ClinicalJob Title Utilization Management RNJob DescriptionThe candidate MUST have Managed Care, audit and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA.. The candidate MUST...
-
Utilization Management RN
3 months ago
Philadelphia, United States Open Systems Technologies Full timeJob DescriptionJob DescriptionContract to Hire position!Job Category Insurance Professional & ClinicalJob Title Utilization Management RNJob DescriptionThe candidate MUST have Managed Care, audit and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA.. The candidate MUST...
-
Registered Nurse Case Manager-Home Health
4 weeks ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRegistered Nurse Case Manager-Home Health Position Summary: Responsible for providing nursing care in the patients' home educating the patient and families on their disease process, medications, and treatments. Providing ongoing assessment, monitoring and treatment to patients in the privacy of their homes. Demonstrates knowledge of and applies...
-
Psychiatric Nurse Practitioner
3 days ago
Philadelphia, PA, United States Public Health Management Corporation Full timePsychiatric Nurse PractitionerPHMC 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. JOB OVERVIEW: The Psychiatric Nurse Practitioner will provide services to adults according to certification, in...
-
Utilization Review Nurse
1 month ago
Philadelphia, United States IntePros Full timeJob Title: Utilization Review NursePosition Type: Part-Time (Every other weekend - Saturday and Sunday, totaling 30 hours per month)Training Requirement: Candidates must be available M-F during typical business hours for a 4-week training period.Job Summary: The Care Management Coordinator is responsible for evaluating members' clinical conditions through...
-
Registered Nurse Case Manager-Home Health
4 weeks ago
Philadelphia, PA, United States Public Health Management Corporation Full timeRegistered Nurse Case Manager-Home Health Position Summary: Responsible for providing nursing care in the patients' home educating the patient and families on their disease process, medications, and treatments. Providing ongoing assessment, monitoring and treatment to patients in the privacy of their homes. Essential Functions: * Demonstrates...
-
Philadelphia, PA, United States Public Health Management Corporation Full timeRegistered Nurse Clinical Manager Manager-Home Health Position Summary: The Home Health Clinical Manager provides ongoing guidance and direction to the multidisciplinary team. Essential Functions: Ensures the provision of quality service by assigned staff. Provides ongoing direction, guidance and evaluation of clinical staff and ensures that professional...
Utilization Management Nurse
4 months 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
