Top 36 Rn utilization review 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
Quality of Care Clinical Coordinator I (RN) - Hybrid
UPMC - Pittsburgh Medical Center —Pittsburgh, PA
- $32.85 - $56.83 an hour
- Full-time
- Nursing
- RN License
- Computer literacy
1d
Quality of Care Clinical Coordinator I (RN) - Hybrid
UPMC —Pittsburgh, PA
- $32.85 - $56.83 an hour
- Full-time
- Nursing
- RN License
- Computer literacy
2d
RN Case Manager (Part Time) - West Penn Hospital
Allegheny Health Network —Pittsburgh, PA
- Part-time
- CPR Certification
- Nursing
- 6 years
RN Case Manager
Community LIFE —Homestead, PA
- $72,000 - $85,000 a year
- Full-time
- Nursing
- RN License
- Word processing
- Travel reimbursement
- Mileage reimbursement
Quick Apply
6d
RN Case Manager
Community LIFE —Wilkinsburg, PA
- $72,000 - $85,000 a year
- Full-time
- Nursing
- RN License
- Word processing
- Travel reimbursement
- Mileage reimbursement
Quick Apply
Part-Time Nursing Case Manager - Skilled Nursing
Concordia at Villa St. Joseph —Baden, PA
- From $34 an hour
- Part-time
- Background check
- Skilled nursing facility
- RN License
- 401(k)
- Paid time off
Quick Apply
9d
RN Case Manager - Home Health
Interim HealthCare —Coraopolis, PA
- $80,000 - $95,000 a year
- Full-time
- CPR Certification
- Management
- RN License
Quick Apply
RN Case Manager (Full Time)- AHN Wexford
Allegheny Health Network —Wexford, PA
- Full-time
- CPR Certification
- Nursing
- 6 years
1d
RN Case Manager Inpatient, Allegheny General
Allegheny Health Network —Pittsburgh, PA
- Full-time
- CPR Certification
- Nursing
- 6 years
Discharge Plan Manager
UPMC —Pittsburgh, PA
- $28.75 - $48.21 an hour
- Full-time
- Nursing
- RN License
- Hospital
1d
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
Discharge Plan Manager, Part Time
UPMC —Pittsburgh, PA
- $26.17 - $60.52 an hour
- Part-time
- Nursing
- RN License
- Hospital
- Paid holidays
- Tuition reimbursement
Nurse Clinical Care Coord-Allegheny County
UPMC —Pittsburgh, PA
- $34.49 - $56.83 an hour
- Full-time
- Nursing
- RN License
- Hospital
9d
Transitional Care Manager
AbsoluteCare —Pittsburgh, PA
- Acute care
- CPR Certification
- Microsoft Excel
Quick Apply
2d
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
5h
RN Manager, Case Management Services
CCN Pharmacy —Pittsburgh, PA
- Nursing
- RN License
- Ability to walk for extended periods
Quick Apply
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical Care —Pittsburgh, PA
- Full-time
- Nursing
- Heavy lifting
- RN License
- Tuition reimbursement
RN Care Coordinator, AVH, Full Time
Allegheny Health Network —Natrona Heights, PA
- Full-time
- CPR Certification
- Nursing
- RN License
14d
NURSE NAVIGATOR, BSN - BREAST CENTER
Excela Square Norwin, Latrobe and Connellsville —North Huntingdon, PA
- 12 hour shift
- Nursing
- RN License
- Writing skills
- COVID-19 protective measures
Quick Apply
1d

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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 :

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 12/31/2025 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

rn utilization review jobs in pittsburgh pa

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

Quality of Care Clinical Coordinator I (RN) - Hybrid

Quality of Care Clinical Coordinator I (RN) - Hybrid

RN Case Manager (Part Time) - West Penn Hospital

RN Case Manager

RN Case Manager

Part-Time Nursing Case Manager - Skilled Nursing

RN Case Manager - Home Health

RN Case Manager (Full Time)- AHN Wexford

RN Case Manager Inpatient, Allegheny General

Discharge Plan Manager

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

Discharge Plan Manager, Part Time

Nurse Clinical Care Coord-Allegheny County

Transitional Care Manager

Pediatric Clinical Care Manager (RN) - Flexible Location

RN Manager, Case Management Services

Dialysis Clinical Manager Registered Nurse - RN

RN Care Coordinator, AVH, Full Time

NURSE NAVIGATOR, BSN - BREAST CENTER

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