Top 32 Utilization review Jobs in Lancaster Pa

Care Management Nurse
Wellspan Health —Ephrata, PA
- Part-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Health insurance
6d
Case Manager RN - Good Samaritan Hospital - Days
Wellspan Health —Lebanon, PA
- Part-time
- Acute care
- Nursing
- RN License
Home Health Clinical Manager
Centerwell —Lancaster, PA
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
10d
Care Nurse Coordinator RN - Behavioral Health Adult Main Inpatient - Days
Wellspan Health —Mount Gretna, PA
- Part-time
- Nursing
- Psychiatry
- RN License
- Retirement plan
Residential Coordinator
Friendship Community —Lititz, PA
- Overtime
- Writing skills
- Mid-level
- Residential
- Wellness program
- Paid holidays
Quick Apply
Director-Care Management Operations
Wellspan Health —York, PA
- Full-time
- Nursing
- RN License
- BLS Certification
- Paid parental leave
- Health insurance
Behavioral Health Community Housing Specialist
Wellspan Health —Lebanon, PA
- Full-time
- Mid-level
- High school diploma or GED
- Driver's License
- Paid parental leave
- Paid time off
12d
Case Management Social Worker - York Case Management - Day
Wellspan Health —York, PA
- Full-time
- Acute care
- Computer literacy
- BLS Certification
- Paid parental leave
- Health insurance
Pharmacist
LifeMD —Lancaster, PA
- $120,000 - $140,000 a year
- Full-time
- Inventory management
- Mid-level
- Math
- AD&D insurance
- Paid holidays
Quick Apply
Social Worker Ambulatory Care Manager (Full Time/Days)
Penn Medicine —Parkesburg, PA
- Full-time
- Microsoft Word
- Spanish
- Master of Social Work
- Tuition reimbursement
Quick Apply
Senior Director Care Management
Wellspan Health —York, PA
- Full-time
- Nursing
- RN License
- Hospital
11d
Clinical Reimbursement Coordinator, RN
Sinking Spring Nursing & Rehab —Sinking Spring, PA
- $40 an hour
- Per diem
- CPR Certification
- Nursing
- RN License
- Disability insurance
- Dental insurance
Rehabilitation Liaison - Surgery & Rehab Hospital - Days
Wellspan Health —York, PA
- Weekends as needed
- Nursing
- Surgery
- RN License
- Paid parental leave
- Health insurance
Social Worker (Weekend Option 1) - York Case Management - Day
Wellspan Health —York, PA
- Part-time
- Acute care
- Computer literacy
- BLS Certification
- Paid parental leave
- Health insurance
4d
Therapist - Substance Use Treatment
Pyramid Healthcare —York, PA
- Full-time
- LMFT
- Addiction Medicine
- Licensed Clinical Social Worker
- Health insurance
- Dental insurance
Quick Apply
5d
Registered Nurse Supervisor
Jewel Healthcare —Elizabethtown, PA
- $45 - $50 an hour
- Full-time
- Nursing
- Patient monitoring
- RN License
- Free parking
- Paid training
Quick Apply
10d
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
9d

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RN Utilization Management - Day Shift
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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utilization review jobs near lancaster pa

Care Management Nurse

Wellspan Health -
Ephrata, PA

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Job Details

Part-time
6 days ago

Benefits

Paid parental leave
Health insurance
Paid time off
Parental leave
Retirement plan

Qualifications

RN License
BLS Certification
Acute care facility experience
Data collection
Associate's degree

Full Job Description

8:30am to 9:00pm

Shifts primarily covering the Emergency Departments but also flexing to in house units based upon department needs

Weekend and holiday rotations required

Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred

General Summary

Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Works in a team type assignment or Care Coordination Team (CCT) Model (Care Manager and Social Worker teams are assigned to patients by physician practice) to address patient care transition needs. Provides leadership in the integration of utilization and care management principles throughout the hospital.

WellSpan Ephrata Community Hospital

One of eight premier hospitals in the WellSpan system, WellSpan Ephrata Community Hospital offers a full range of leading-edge inpatient, outpatient and emergent care services. The hospital is noted for its distinct ability to combine state-of-the-art medical technology with quality, compassionate care to meet the needs of the more than 550,000 residents of northern Lancaster County and the surrounding area. As a full-service, non-profit acute-care hospital, with a 141 licensed bed capacity, WellSpan Ephrata Community Hospital admits approximately 5,500 patients annually. Nearby WellSpan Ephrata Cancer Center supports the hospital as part of WellSpan’s regional network of five cancer centers. WellSpan Ephrata Community Hospital was one of several WellSpan Health hospitals honored by U.S. News & World Report with the High Performing recognition for 2022-23.

Duties and Responsibilities

Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
Assists the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost.
Identifies conditions which require care management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
Assists with the collection and analysis of utilization patterns and denied cases.
Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).

Common Expectations:

Prepares and maintains appropriate documentation as required.
Maintains established policies and procedures, objectives, quality assessment and safety standards.
Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

Associates Degree Required

Work Experience:

2 years Recent acute care experience. Required
Utilization management, care management, or clinical nursing specialty. Preferred
Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred

Licenses:

Licensed Registered Nurse Upon Hire Required or
Registered Nurse Multi State License Upon Hire Required and
Basic Life Support Upon Hire Required

Knowledge, Skills, and Abilities:

Excellent interpersonal/communication skills.

Benefits Offered:

Comprehensive health benefits
Retirement savings plan
Paid time off (PTO)
Education assistance
Financial education and support, including DailyPay
Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)

WellSpan Health’s vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region’s largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.

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utilization review jobs in lancaster pa

Care Management Nurse

Case Manager RN - Good Samaritan Hospital - Days

Home Health Clinical Manager

Care Nurse Coordinator RN - Behavioral Health Adult Main Inpatient - Days

Residential Coordinator

Director-Care Management Operations

Behavioral Health Community Housing Specialist

Case Management Social Worker - York Case Management - Day

Pharmacist

Social Worker Ambulatory Care Manager (Full Time/Days)

Senior Director Care Management

Clinical Reimbursement Coordinator, RN

Rehabilitation Liaison - Surgery & Rehab Hospital - Days

Social Worker (Weekend Option 1) - York Case Management - Day

Therapist - Substance Use Treatment

Registered Nurse Supervisor

Appeals Professional III (Licensed Clinician)

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