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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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Philadelphia, Pennsylvania, United States Health Partners Plans Full timeUtilization Management NurseAbout the Role:We are seeking a skilled and detail-oriented Utilization Management Nurse to join our team at Health Partners Plans. As a Utilization Management Nurse, you will play a critical role in ensuring cost-effective and quality utilization management in the acute level of care setting for the pediatric and adult population...
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RN MICU PRN Einstein Nights
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Utilization Management RN PRN
3 months ago
Reference #: 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 and healthcare team to ensure open lines of communication to ensure optimal outcomes and patient care. Minimum Education and Experience Requirements: Education: Bachelors Nursing, required AND Experience: 3 ndash; 5 years case management experience, discharge planning or utilization management experience required. Minimum Certifications, Registration or License Requirements: Registered Nurse in state of employment. Certification in InterQual criteria preferred Covid Vaccination is a requirement for employment at Jefferson for employees working at Jeffersonrsquo;s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson. About Jefferson Nationally ranked,Jefferson, which is principally located in the greaterPhiladelphiaregion and southernNew Jersey, is reimagining health care and higher education to create unparalleled value.Jeffersonis more than 42,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow#39;s professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of SidneyKimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top healthcare systems in the country and the largest provider in thePhiladelphiaarea, serves patients through millions of encounters each year at 17 hospitals and more than 160 outpatient and urgent care locations throughout the region. Jefferson Health Plansis a not-for-profit managed health care organization providing a broad range of health coverage options inPennsylvaniaandNew Jerseyfor more than 35 years. As an employer, the Jefferson Enterprise maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.
