Top 19 Utilization review nurse Jobs in Philadelphia Pa

Telephonic Case Manager I
CorVel Corporation —Norristown, PA
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Utilization Review Analyst
EAGLEVILLE HOSPITAL —Eagleville, PA
- $50,000 - $57,000 a year
- Hospital
- Mid-level
- Office
Quick Apply
PRN Clin Resource Coordinator at HUP
Penn Medicine —Philadelphia, PA
- PRN
- Nursing
- Microsoft Outlook
- RN License
- Tuition reimbursement
Quick Apply
10d
Care Manager
GSPP Rehabilitation —Philadelphia, PA
- 8 hour shift
- Nursing
- RN License
- Licensed Clinical Social Worker
Registered Nurse Case Manager- Inpatient Units
Children’s Hospital of Philadelphia —Philadelphia, PA
- $101,300 - $129,100 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Quick Apply
8d
Admissions Review Specialist
Avenues Recovery —Warminster, PA
- Full-time
- Mid-level
- Master's degree
- Organizational skills
- Paid holidays
- Health insurance
Quick Apply
2d
Care Progression Manager, Full-Time, Days, Washington Township (Hybrid)
Thomas Jefferson University and Hospitals —Turnersville, NJ
- $80,720.21 - $117,902.40 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Hospital
- AD&D insurance
- Disability insurance
10d
HomeCare Population Health Nav
Redeemer Health —Philadelphia, PA
- PRN
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
1d
Case Manager ( RN / RT / SW / LPN )
Select Specialty Hospital - Willingboro —Willingboro, NJ
- $78,000 - $113,000 a year
- Full-time
- RN License
- Inpatient
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
Operating Room Manager ASC, 5 days a week
Riddle Surgical Center —Media, PA
- Full-time
- Nursing
- Surgery
- Patient monitoring
- Free parking
- Wellness program
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Psychiatric Mental Health Nurse Practitioner
The Volpicelli Center, Inc. —Plymouth Meeting, PA
- $60 - $75 an hour
- Part-time
- Hybrid work
- Background check
- Vital signs
- Psychiatry
- Professional development assistance
- Flexible schedule
Quick Apply
Team Manager Home Care
VITAS Healthcare —Blue Bell, PA
- Full-time
- RN License
- Mid-level
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
9d
Nurse Practitioner
Vital Urgent Care —Philadelphia, PA
- $67 - $70 an hour
- Part-time
- Spanish
- HIPAA
- Inpatient
Quick Apply

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MDS Coordinator
Eden Senior Care —Yeadon, PA
Must hold an active LPN or RN license in the state of Pennsylvania. Participate in the implementation, updating and review of the resident care plan.
$95,000 - $105,000 a year
Quick Apply
5d
Utilization Review Per Diem Elkins Park
Thomas Jefferson University and Hospitals —Philadelphia, PA
Conducts psychosocial assessment/reassignment of patients/significant others relating to the social, emotional and cognitive capabilities of patients in…

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Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
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…
$40.40 an hour
10d
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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Telephonic Case Manager I

CorVel Corporation -
Norristown, PA

Quick Apply

Job Details

Full-time
$63,739 - $95,264 a year

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

Customer communication

Full Job Description

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel.

This is a remote role.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source
Provide assessment, planning, implementation, and evaluation of patient's progress
Evaluate patient's treatment plan for appropriateness, medical necessity, and cost effectiveness
Utilize medical and nursing knowledge to discuss the current treatment plan/alternate treatment plans with the physician
Make medical recommendations of available treatment plans to the payer
Implement care such as negotiating and coordinating the delivery of durable medical equipment and nursing services
Devise cost-effective strategies for medical care
Required to prepare organized reports within a specified timeframe
Minimum Productivity Standard is 95% per month
Additional duties as assigned

KNOWLEDGE & SKILLS:

Ability to make independent medical decisions and recommendations to all parties
Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment
Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers
Excellent written and verbal communication skills
Ability to meet designated deadlines
Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
Strong interpersonal, time management, and organizational skills
Ability to work both independently and within a team environment

EDUCATION & EXPERIENCE:

Bachelor’s degree required, BSN preferred
Graduate of accredited school of nursing
Current RN Licensure in state of operation
3 or more years of recent clinical experience, preferably in rehabilitation
URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no nationally recognized certification is present at time of hire
Strong clinical background in orthopedics, neurology, or rehabilitation preferred
Strong cost containment background, such as utilization review or managed care helpful
Certification as a CIRS or CCM preferred

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $63,739 - $95,264

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management (https://www.corvel.com/company/careers/)

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL:

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

#LI-Remote

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

utilization review nurse jobs in philadelphia pa

Telephonic Case Manager I

Utilization Review Analyst

PRN Clin Resource Coordinator at HUP

Care Manager

Registered Nurse Case Manager- Inpatient Units

Admissions Review Specialist

Care Progression Manager, Full-Time, Days, Washington Township (Hybrid)

HomeCare Population Health Nav

Case Manager ( RN / RT / SW / LPN )

Operating Room Manager ASC, 5 days a week

Psychiatric Mental Health Nurse Practitioner

Team Manager Home Care

Nurse Practitioner

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