Top 17 Utilization review nurse Jobs in Pittsburgh Pa

RN Case Manager (Full Time 40 Hours), West Penn Hospital
Allegheny Health Network —Pittsburgh, PA
- Full-time
- CPR Certification
- Nursing
- 6 years
- Free parking
- Commuter assistance
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —Cranberry Township, PA
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
RN Case Manager (Full Time, 40 Hours), West Penn Hospital
Allegheny Health Network —Pittsburgh, PA
- Full-time
- CPR Certification
- Nursing
- 6 years
- Free parking
- Commuter assistance
RN Case Manager Inpatient, Allegheny General
Allegheny Health Network —Pittsburgh, PA
- Full-time
- CPR Certification
- Nursing
- 6 years
Pediatric Clinical Care Manager (RN) - Flexible Location
UPMC —Pittsburgh, PA
- $36.73 - $60.52 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Health insurance
RN Case Manager (Full Time)- AHN Wexford
Allegheny Health Network —Wexford, PA
- Full-time
- CPR Certification
- Nursing
- 6 years
Clinical Care Manager (RN) - Pleasant Hills/Munhall
UPMC —Pittsburgh, PA
- $36.73 - $60.52 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
Clinical Care Manager (RN) - Allegheny County
UPMC —Pittsburgh, PA
- $36.73 - $60.52 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
- Flexible schedule
8d
Clinical Care Manager (RN) - Allison Park
UPMC —Pittsburgh, PA
- $36.73 - $60.52 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
RN Care Coordinator, AVH, Full Time
Allegheny Health Network —Natrona Heights, PA
- Full-time
- CPR Certification
- Nursing
- RN License
Psychiatric Mental Health Nurse Practitioner (PMHNP) - In Person
MTC Care —Monroeville, PA
- From $145,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- Microsoft Outlook
Nurse Practitioner - Wexford
Clay Consulting —Wexford, PA
- $120,000 - $150,000 a year
- Extended hours
- Nursing
- Blood sampling
- Microsoft Excel
Quick Apply
Remote Utilization Review RN or LVN (Inpatient/SNF Team.) Must have CA license.
Dragonfly Global —United States
- $48.00 - $50.48 an hour
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Paid holidays
- Disability insurance
Quick Apply

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Clinical Informatics Specialist- UPMC East
UPMC —Monroeville, PA
Clinical professionals who have a state-regulated license shall be expected to maintain their license in good standing while employed in this role.
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7d
Registered Nurse - Clinical Informatics Specialist
US Department of Veterans Affairs —Pittsburgh, PA
*Graduate of a school of professional nursing* approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the…
$71,798 - $147,862 a year
Quick Apply

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Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
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RN Case Manager (Full Time 40 Hours), West Penn Hospital

Allegheny Health Network -
Pittsburgh, PA

Apply Now

Job Details

Full-time

Benefits

Free parking
Commuter assistance

Qualifications

CPR Certification
BLS Certification
Patient care

Full Job Description

Company :

Allegheny Health Network

Job Description :

This role is an on-site role at AHN West Penn Hospital located in the Bloomfield neighborhood of Pittsburgh, PA. On site requirements are Monday-Friday 8am-4:30pm.

WEST PENN HOSPITAL:

West Penn Hospital has four-time Magnet® recognition, private patient rooms, free employee parking and a generous benefit package (for full-time and part-time status employees). They are nationally recognized for their burn care, and the only pediatric burn center in western Pennsylvania to be verified by the American Burn Association and the American College of Surgeons. They are also ranked in the nation's top-50 hospitals for OB-GYN care by the US News and World Report.

ALLEGHENY HEALTH NETWORK:

At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities. AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees.

GENERAL OVERVIEW:

This job has responsibility for creating, implementing, and evaluating care plans for patients and their families/caregivers across the health continuum. Incumbents will utilize nationally recognized standards of practice for case management by collaborating with providers, clinical teams, health plans, and external partners while advocating for patients and caregivers in order to align goals and plans. Incumbents will serve as professional role models, utilizing their expertise in care management to promote a collaborative professional environment that optimizes outcomes, engages patients/caregivers in their healthcare, and supports effective resource utilization. Serves as key team members in the management of readmissions, length of stay, ED utilization, and patient/family satisfaction.

ESSENTIAL RESPONSIBILITIES:

Contributes to or completes comprehensive assessment of patients and their families/caregivers, inclusive of clinical/physical needs, social determinants of health, and economic barriers impacting their ability to manage their health. (20%)
Effectively identifies barriers and analyzes situations for assigned patient population, including risk for admission/readmission, external resources, and patient/family capacity in order to determine safe plans for transition and care coordination. (20%)
Coordinates the clinical care with the patient, family, provider(s), and members of the interdisciplinary team. (25%)
Advocates for patients and families through effectively communicating with providers, interdisciplinary team members, payers, and post-acute partners to assure effective outcomes and care. (15%)
Leverage understanding of industry standards to provide applicable education to patients, families, providers, and interdisciplinary team partners including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and limitations, transition planning requirements, length of stay, and resource utilization. (10%)
Actively seeks professional development opportunities through professional certification, mentoring/precepting, and/or participation on department/hospital/system committees. (5%)
Adheres to the policies, procedures, rules, regulations, and requirements of hospitals and other clinical settings. (5%)

QUALIFICATIONS:

Minimum

Bachelor’s Degree in Nursing -OR- Bachelor’s Degree and Nursing Diploma -OR- 6 years of relevant experience in lieu of a degree
3 years in a clinical nursing role
Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
Professional Certification within 5 years of start date. Incumbents in role as of 12/1/2022 have until 12/31/2026 to obtain
Critical thinking and problem solving
Flexibility and adaptability to change
Strong communication and collaboration skills with ability to tailor style according to target audience (providers, peers, clinical team members, patients, families)
CPR – American Heart Association
Act 34 Criminal Background Clearance Certificate
Act 33 Child Abuse Clearance Certificate
Act 73 FBI Fingerprinting Criminal Background Clearance Certificate

Preferred

Nationally recognized Case Management Certification
Transition planning and understanding of community and facility resources
Knowledge of motivational interviewing techniques
BSN

LICENSES or CERTIFICATIONS

Required

None

Preferred

ACM Certification (Accredited Case Manager) - American Case Management Association - American Case Management Association
Case Management - American Board of Occupational Health Nurses (ABOHN) and
Certified Case Manager (CCM)
Commission for Case Manager Certification (CCMC)

#ind123

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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Refine Your Search

utilization review nurse jobs in pittsburgh pa

RN Case Manager (Full Time 40 Hours), West Penn Hospital

Hospice Clinical Team Manager (RN Required)

RN Case Manager (Full Time, 40 Hours), West Penn Hospital

RN Case Manager Inpatient, Allegheny General

Pediatric Clinical Care Manager (RN) - Flexible Location

RN Case Manager (Full Time)- AHN Wexford

Clinical Care Manager (RN) - Pleasant Hills/Munhall

Clinical Care Manager (RN) - Allegheny County

Clinical Care Manager (RN) - Allison Park

RN Care Coordinator, AVH, Full Time

Psychiatric Mental Health Nurse Practitioner (PMHNP) - In Person

Nurse Practitioner - Wexford

Remote Utilization Review RN or LVN (Inpatient/SNF Team.) Must have CA license.

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