Utilization review nurse jobs in Camden, NJ - 193 jobs

ChristianaCare is currently hiring for an Acute Care Nurse Practitioner or Physician Assistant to join the surgical services team at our main campus in Newark, DE. This position will provide consultative coverage for neurosurgical patients in partnership with our neurosurgeons. The PA or NP will work closely with the multidisciplinary teams and attending physicians and serve as a liaison for the care of neurosurgical patients. The position is Monday through Friday, 8 hour shifts. Why ChristianaCare? * Generous Continuing Education Time and Allowance * Substantial PTO plus 12-Week Fully Paid Parental Leave * Opportunities for Career Growth * 403(b) and Defined Contribution Plan Retirement Options with Employer Match * Annual Quality Incentive Bonus Requirements: * Licensed or eligible for Nurse Practitioner or Physician Assistant license in the state of Delaware * Acute Care NP license required * ACLS required * DEA required * Experience managing neurosurgical patients and general surgical management preferred #J-18808-Ljbffr

ChristianaCare is currently hiring for an Acute Care Nurse Practitioner or Physician Assistant to join the surgical services team at our main campus in Newark, DE. This position will provide consultative coverage for neurosurgical patients in partnership with our neurosurgeons. The PA or NP will work closely with the multidisciplinary teams and attending physicians and serve as a liaison for the care of neurosurgical patients. The position is Monday through Friday, 8 hour shifts. Why ChristianaCare? Generous Continuing Education Time and Allowance Substantial PTO plus 12-Week Fully Paid Parental Leave Opportunities for Career Growth 403(b) and Defined Contribution Plan Retirement Options with Employer Match Annual Quality Incentive Bonus Qualifications Licensed or eligible for Nurse Practitioner or Physician Assistant license in the state of Delaware Acute Care NP license required ACLS required DEA required Experience managing neurosurgical patients and general surgical management preferred Annual Compensation Range $119,583.00 - $153,472.00. This pay rate/range represents ChristianaCare's good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including, without limitation, skills, relevant experience, and qualifications as they relate to specific job requirements. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law. #J-18808-Ljbffr

Malvern Behavioral Health is currently seeking a full time Utilization Management Coordinator for our new Acute Inpatient units located at 3905 W. Ford Road, Philadelphia, PA 19131! This position is a full time, benefit eligible position! To conduct continued stay reviews of medical record documentation using pre-established criteria and to provide updated progress reports to third party payers in order to receive certification for payment. This individual will perform all utilization reviews for acute psychiatric and residential drug and alcohol clients. Summary of Essential Position Functions: Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized and authorization numbers. Coordinates reviews, appeals and maintains denial logs. Performs concurrent continued stay reviews using pre-established criteria. Understands Medical Necessity and ASAM criteria and communicates this information accurately to insurance carriers. Consults with appropriate treatment team members for clarification of documentation as needed. Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals. Inputs data accurately for financial purposes. Maintains accurate review sheets of all reviews performed. Assists supervisor and departments in identifying patterns of mis-utilization. Responds to telephone messages quickly, professionally and appropriately. Participates in continuing education to reach professional growth objectives, including maintenance of own credentials, certifications and participating in committees. Attendance at case conference for clinical updates. Maintains and communicates authorization information to all team members. Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required. Educates new staff members about Medical Necessity criteria, high-quality documentation and insurance needs. Develops relationship and rapport with payers and third party insurance reviewers Initiates and follows the precertification and/or single case agreement process as necessary. Supervisory Responsibilities: None Benefits This position is a full time, benefit eligible position. Benefits offered include, but not limited to: Medical Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off 401K plan with company match Qualifications Qualifications: To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. This position requires individuals that are client focused; team oriented; great interpersonal and communication skills; flexible to sudden changes in workload, emergency or staffing; dependable; problem solving skills; focused on compliance and performance quality. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience: Education and/or Experience: Master's Degree or graduate of an accredited nursing program with licensure in the state of Pennsylvania. Previous utilization review experience preferred. Technical/Computer Skills: Microsoft office and billing experience preferred. Requires much independent action and decision making and ability to organize own work. Knowledge of facility systems and organization as they pertain to medical records and organization review. Knowledge of medical terminology, medical record format and content. Work Environment and Hazards: Risk of exposure to communicable disease. Possible exposure to intoxicated, disruptive, and/or agitated patients. Protected from weather conditions. Physical Requirements: Sedentary work primarily - lifting 10 lbs. maximum *Malvern Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.*

Job DescriptionDescription: The Renfrew Center of Philadelphia, offers an unmatched opportunity, in the field of eating disorders, for a Utilization Review Coordinator to work in an environment that changes lives. The Renfrew Center has opportunities for individuals of all backgrounds, that have the desire and passion to foster a positive outcome and impact on our patients' lives. The Renfrew Center's research-based treatment model, for eating disorders, is focused on treating the whole person and helping them lead a rich and fulfilling life. Our commitment to you - We are committed to providing every employee the opportunity for personal and professional development through: 401(k) with company match Healthcare benefits Vacation and sick days Employee referral program Employee discounts to various stores, amusement parks, events, etc. Continuing education (CE) programs and training Advancement opportunities within the organization Position Responsibilities: Complete daily treatment pre-certifications with insurance/managed care companies. Complete daily concurrent reviews with insurance/managed care companies. Understand and present acuity, rationale for continued stay, treatment goals and discharge criteria from a medical record. Be familiar with various managed care companies medical necessity criterion and appropriate application, to guide the concurrent review process. Maintain accurate and complete documentation, including computer documentation. Participate and effectively collaborate with a treatment team as an active team member. Demonstrate an understanding of the functional/developmental age of the individual served. Requirements: Education, Competencies and Credentials: Master's degree in Human Services, Psychology, or Social Work required. A minimum of 1-2 years of training/working in a residential or health care facility is required. Previous experience working with eating-disorder patients is highly preferred. Familiarity with psychiatric disorders is required. Hours: 40 hours per week, Monday through Friday. The Renfrew Center provides women with the tools they need to succeed - in recovery and life. Offering a warm, nurturing environment, Renfrew emphasizes respect for the unique psychology of women, the importance of a collaborative, therapeutic relationship, and the belief that every woman needs to actively participate in her growth and recovery. The Renfrew Center - An Equal Employment Opportunity Employer, devoted to diversity, equity, and inclusion.

**Become a part of our caring community and help us put health first** Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Conviva, a wholly-owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Preferred Locations:** Daytona, FL, Louisville, KY, San Antonio, TX **Use your skills to make an impact** **Role Essentials** + Active Unrestricted RN license + Possession of or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Valid driver's license and/or dependable transportation necessary + Travel for offsite Orientation 2 to 8 weeks + Travel to offsite meetings up to 6 times a year as requested + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers + Available for On Call weekend/holiday rotation if needed **Role Desirables** + Education: BSN or bachelor's degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Additional Information** We offer tangible and intangible benefits such as medical, dental and vision benefits, 401k with company matching, tuition reimbursement, 3 weeks paid vacation time, paid holidays, work-life balance, growth, a positive and fun culture and much more. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-18-2026 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

Job Details The Utilization Management Nurse is responsible assure cost effective, quality utilization management in the acute level of care setting for the pediatric or adult population in the post-acute inpatient setting (i.e.,SNF/Rehab). Also, responsible to review clinical information provided by facilities and communicates UM determinations maintaining timeliness. Job Description Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Review and track emergency admissions to identify appropriate level of care for acute and post-acute inpatient services. Perform concurrent review and/or admission review on all hospital admissions using InterQual criteria guidelines. Track assigned cases for timely reviews/updates and decisions as reflected in case documentation. Request and review medical records to identify appropriate acute care days and approve or refer questionable days to the medical director for decision. Function as a liaison between providers, members and interdepartmentally. Serve as resource for physicians, PCPs, Utilization Review departments and all medical providers. Identify trends that impact on utilization at hospitals during the review process and help resolve them. Maintain departmental and regulatory timeframes for utilization decisions. Contributes to the development and enhancement of documentation, tracking tools and process flows Maintains collaborative and effective cross- functional training within the Utilization Management Department Utilization management perform after hour's on-call coverage. Participates in relevant work groups and provide deliverables as necessary Successful and timely completion of assignments in accordance with departmental and Company operational objectives and seeks feedback on performance. Ensures that assignments are scheduled and completed in an accurate and timely manner. Maintains detailed knowledge of the status of all assignments and routinely updates the manager, as appropriate Responsible to for after hour on call shifts as needed Performs all other duties as assigned Education and Experience: Graduate of an accredited nursing program (Associate's or Bachelor's degree in Nursing). BSN preferred. Minimum of 2-3 years of clinical nursing experience. At least 1 year of utilization management, case management, or managed care experience preferred. Work Shift Workday Day (United States of America) Worker Sub Type Regular Employee Entity Health Partners Plans, Inc. Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel 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 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educa tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. Benefits Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance. For more benefits information, please click here

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description • Evaluate clinical information submitted by providers against plan review criteria and benefit guidelines • Utilize clinical information to determine if criteria for medical necessity and benefit guidelines are met • Document pertinent case information for approvals and denials- refer cases failing to meet Interqual to Medical Director • Act as liaison to ensure services are provided in the least restrictive, most cost effective and clinically appropriate setting • ID and resolve problems that could interfere with provider's continuity and coordination of care of members- refer unresolved problems to the manager Qualifications • Clear and active RN license in state of PA • Minimum AS in nursing • 2 years' experience in acute care hospital AND • 2 years' experience in managed care, quality assurance or utilization review setting Additional Information Hours for this Position: 40 hours a week M-F, daytime hours Advantages of this Opportunity: • Competitive salary, negotiable based on relevant experience • Benefits offered, Medical, Dental, and Vision • Fun and positive work environment • Right to Hire opportunity • Can start as early as next week Interested in being considered? If you are interested in applying to this position, please contact Steph Zymowski at 407-636-7030 ext.220 and click the Green I'm Interested Button to email your resume.

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care. Key Responsibilities Conduct prospective, concurrent, and retrospective drug utilization reviews. Evaluate prescribing patterns against clinical guidelines and formulary criteria. Identify potential drug interactions, duplications, and inappropriate therapy. Prepare recommendations for prescribers to optimize therapy and reduce risk. Document reviews and ensure compliance with state, federal, and health plan requirements. Contribute to quality improvement initiatives and pharmacy program development. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply. Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication. Why This Role? Impact: Shape prescribing decisions that affect thousands of patients. Growth: Build expertise in managed care and population health pharmacy. Flexibility: Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive salary, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations. Apply Today Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

We are seeking a Nurse Case Manager to join our Residential Services team. This role ensures the health and well-being of individuals with intellectual disabilities in group homes and Adult Day Programs through comprehensive healthcare planning and coordination. This position is M-F during first shift hours. What You'll Bring: Compassion and commitment to improving the lives of individuals with intellectual disabilities. Strong communication and collaboration skills to work effectively with families, healthcare providers, and interdisciplinary teams. Ability to manage multiple priorities and maintain accuracy in a fast-paced environment. What You'll Have: Licensure: Licensed Practical Nurse (LPN) in Pennsylvania; qualified to pass medications. Experience: Minimum 5 years of clinical experience in acute or long-term care settings; experience with intellectual disabilities preferred. Certifications: First Aid and CPR preferred. Excellent organizational skills and attention to detail. A Typical Day May Include: Developing and reviewing individualized healthcare plans. Visiting group homes to assess health and safety needs. Coordinating medical appointments, annual physicals, and follow-up care. Managing medication administration processes and ensuring compliance with regulatory guidelines. Acting as a liaison between individuals, families, healthcare providers, and staff. Performs quarterly nursing assessment of individuals in the Older Adult Day Services as assigned. Creates and completes quarterly staff trainings in the Older Adult Day Service as assigned. Participating in interdisciplinary meetings and on-call rotations. Completing quarterly nursing assessments and staff training for Older Adult Day Services.

HealthPlus Staffing is seeking a Nurse Case Manager in Philadelphia, PA. The Case Manager will provide help to pregnant women and children in getting the health care and social services needed. Job Requirements: Bachelor's degree with major course work in sociology, social work, social welfare, psychology, gerontology, anthropology, other related social sciences, criminal justice, theology, nursing, healthcare administration, counseling, or education or Registered Nurse Licensed Practical Nurse or Certified Nurse Assistant (CNA) or Medical Assistant plus two (2) years of mental health direct care experience. Individuals using these criteria must receive a written waiver from the DBHIDS prior to hire. Must have Active nurse License in the state of Illinois Compensation: Commensurate on experience Benefits: Full Benefits Pediatrics Schedule: Monday to Friday Location: Philadelphia, PA Reliably commute or planning to relocate before starting work (Required) Education: Bachelor's (Preferred) Experience: Nursing: 1 year (Preferred) For more info please reach out to us at Recruitment@HealthPlusStaffing.com or call at 561-291-7787

Job Description Hospice Nurse Case Manager Full-time | Philadelphia, PA | Monday-Friday with occasional on-call rotation We are seeking a compassionate and experienced Hospice Nurse Case Manager to join a dedicated interdisciplinary team providing high-quality end-of-life care to patient's in their residence. The ideal candidate is a skilled clinician who thrives on building strong relationships with patients and families, coordinating care plans, and ensuring that each individual's final journey is met with dignity, comfort, and compassion. You'll be joining a passionate teams of physicians, NPs, chaplains, social workers, and aides. Responsibilities: Manage a caseload of hospice patients, conducting comprehensive assessments and developing individualized care plans. Provide direct skilled nursing care and education to patients and caregivers in the home setting. Coordinate care with physicians, social workers, chaplains, and other members of the hospice team to ensure holistic, patient-centered care. Monitor patient status and adjust care plans as needed to maintain optimal comfort and symptom management. Document assessments, interventions, and communications in accordance with state, federal, and agency guidelines. Serve as a clinical resource and advocate for patients and families, ensuring their physical, emotional, and spiritual needs are met. Participate in regular interdisciplinary team meetings and case conferences. Rotate in after-hours or weekend on-call coverage as assigned. Qualifications: Current Registered Nurse (RN) license in the state of Pennsylvania Minimum of 1-2 years of hospice or home health nursing experience strongly preferred. Strong clinical assessment, communication, and organizational skills. Empathetic, patient-centered approach with the ability to support families during emotionally challenging times. Valid driver's license, reliable transportation Benefits: Competitive salary and mileage reimbursement Comprehensive health, dental, and vision insurance Paid time off and retirement plan options Ongoing training and professional development opportunities Supportive and collaborative work environment

AOT Outreach Nurse Coordinator- Kidney Transplant- Temple Hospital (40/hrs, Day Shifts) - (257105) Description The AOT Outreach Nurse Coordinator works closely with medical and program leadership. Supporting the liver and kidney transplant programs by coordinating the delivery of care for the transplant patients in the satellite clinics throughout the Temple service area. Serves as a liaison between Temple University Hospital and our partner organizations to improve the delivery of care. Under the direction of the Director Clinical Transplant Services, partners with the QAPI team to develop and report on quality improvement projects related to Temple's AOT satellite clinics. Supports the outreach and education coordinator as needed to provide clinical support for dialysis center visits. Demonstrates a thorough knowledge of nursing theory and practice involved in providing nursing care. Familiarity with organization and function of departments, policies, procedures and regulations. Orchestrates the care of patients with end stage organ disease. This position requires regular travel between Temple University Hospital and Satellite locations. EducationBachelor's Degree in Nursing from an accredited Nursing program. RequiredMaster's Degree in Nursing from an accredited Nursing program. PreferredExperience3 years experience in nursing. RequiredGeneral Experience and knowledge of Electronic Medical Record. RequiredGeneral Experience in a Transplant program. PreferredLicensesPA Registered Nurse License RequiredMulti State Compact RN License Required Or Your Tomorrow is Here!Temple Health is a dynamic network of outstanding hospitals, specialty centers, and physician practices that is advancing the fight against disease, pushing the boundaries of medical science, and educating future healthcare professionals. Temple Health consists of Temple University Hospital (TUH), Fox Chase Cancer Center, TUH-Jeanes Campus, TUH-Episcopal Campus, TUH-Northeastern Campus, Temple Physicians, Inc. , and Temple Transport Team. Temple Health is proudly affiliated with the Lewis Katz School of Medicine at Temple University. To support this mission, Temple Health is continuously recruiting top talent to join its diverse, 10,000 strong workforce that fosters a healthy, safe and productive environment for its patients, visitors, students and colleagues alike. At Temple Health, your tomorrow is here!Equal Opportunity Employer/Veterans/DisabledAn Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. Your Tomorrow is Here!Temple University Hospital is a nationally respected teaching hospital on Temple University's bustling Health Sciences Center campus. The hospital provides a comprehensive array of healthcare services both basic and complex to patients from around the corner, across the country and around the world. As the chief clinical training site for the Lewis Katz School of Medicine at Temple University, the hospital provides a dynamic environment for high-quality care, teaching, and cutting edge research. Primary Location: Pennsylvania-PhiladelphiaJob: Nursing Admin & ManagementSchedule: Full-time Shift: Day JobEmployee Status: Regular

Monarch/Brandywine Senior Living Company Culture and Values: At Monarch Communities, we value compassion, innovation, and community. Our team is committed to making a meaningful impact on the lives of our residents and fostering a collaborative and supportive work environment. Job Description Salary: $32.00 - $34.00 Hourly Have you cared for others most of your life and decided to make a career out of your natural talent? Do you gain great satisfaction from your ability to calm others and triage a situation or ailment? If this sounds like you - then you have found the best employer who will appreciate your work as a Licensed Practical Nurse! What will you get to do as an LPN? Provide warm and engaging personal care services, assistance, support, and companionship. Administer or assist with medication for residents according to the Resident Care Plan. Engage residents while checking on their well-being and communicate changes in condition or Care Plan. Inspire your team and collaborate with the Wellness Director and Assistant Wellness Director in assessing and documenting resident assessments at state or Retirement Unlimited specified intervals. Why we want you on our team: You have a positive attitude and love working with people! A graduate of a state approved school of nursing. A current state license as a Licensed Practical or Vocational Nurse. No experience needed! We welcome new grads and experienced nurses! What can our community offer you? Pleasant Teamwork Environment Hands-On Immersive Training and Learning experiences. Resort-style Community Supportive Corporate Team Referral Bonus Program Free Meal Daily Competitive Wages Many Opportunities for Growth and Development Being a community team member means having the opportunity to be something more than an employee. It is an opportunity to serve and work with vision, meaning, and purpose. At our community you can both grow as a person and in your career. Great opportunities await! Full Time Schedule: (3:00pm-11:00pm) Week 1: Monday, Tuesday, Wednesday, Thursday, Saturday / Week 2: Sunday, Tuesday, Wednesday, Thursday, Friday Qualifications Graduation from an accredited School of Nursing, with current LPN license At least 2 years' experience with long-term care, assisted living, home health or hospital setting preferred Experience working with residents with Alzheimer's or other related dementias Ability to handle multiple tasks Knowledge of federal and state regulations, and of nursing practices, techniques and methods applied to health and wellness resident Proficiency in computer skills, Microsoft Office (Windows, Outlook, Excel) with the ability to learn new applications While performing the duties of this job, the associate is often required to stand, walk, sit, use fine and gross motor skills, reach with hands and arms, balance, stoop, kneel, crouch, talk, hear, and smell. An individual in this position will be required to lift or carry weight in up to 50 lbs. Intermittent physical activity includes lifting and supporting residents. The associate must use proper body mechanics. Additional Information Benefits Offered (Full Time): Health Insurance: Medical/Rx, Dental, and Vision Ancillary Benefits: Life Insurance/AD&D, Short Term Disability and Long-Term disability Basic Life & Accidental Death & Dismemberment (AD&D) Insurance FSA (Commuter/Parking) Employee Assistance Program (EAP) 401(k) Retirement with Company Match Paid Time Off (PTO) and Holidays Tuition Reimbursement Other Compensation Programs: Employee Referral Bonus Resident Referral Bonus Equal Opportunity Statement: Monarch Communities and Brandywine Senior Living is an Equal Opportunity Employer. We comply with all applicable federal, state, and local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? **Hospital of the University of Pennsylvania is looking for a FT Ambulatory Nurse I for the Surgery OutPt Colon Rectal department!!!!** **Schedule: M-F 8am-4:30pm 1 Hybrid day** **Location: 3400 Spruce St.** Summary: The Ambulatory Nurse I New to Practice/Apprentice is a newly licensed new-to-practice RN or RN with less than 15 months of experience that demonstrates basic safe practice within the organizational professional practice model. The Ambulatory Nurse I New to Practice/Apprentice seeks guidance to integrate concepts, knowledge, skills, and attitudes to meet standards for competent professional nursing practice as specified in the Ambulatory Nurse I New to Practice/Apprentice position description addendum. The Ambulatory Nurse I New to Practice/Apprentice exhibits UPHS organizational behavioral competencies which reflect its mission and are embedded in the professional practice competency domains. The Ambulatory Nurse I New to Practice/Apprentice is accountable for the provision of direct care to patients who may range in age from infancy to the elderly and demonstrates within the competency domains of Continuous Quality Improvement, Evidence-Based Practice and Research, Leadership, Person and Family-Centered Care, Professionalism, Safety, Teamwork, and Technology/ Informatics (Definitions listed below). The Ambulatory Nurse I New to Practice/Apprentice works closely with the interprofessional health care team to facilitate the coordination of care across the continuum. The nurse focuses on developing the knowledge and skills necessary to provide individualized care based on physical, psychosocial, cultural, educational, safety, and age-appropriate considerations of assigned patients. The Ambulatory Nurse I New to Practice/Apprentice requires consultation with more experienced clinicians and benefits from feedback while demonstrating growth in the ability to care for increasingly complex patients. The nurse demonstrates how the nursing practice impacts the organizational vision, mission, goals, and the care delivery system. The nurse complies with all regulations and standards of regulatory and accrediting bodies. The Ambulatory Nurse I New to Practice /Apprentice must complete all Ambulatory Nurse I competencies and is expected to advance to the Ambulatory Nurse II Colleague level by 15 months of professional practice. See addendum. Responsibilities: + Evidence-Based Practice and Research: The nurse evaluates and integrates best current evidence with clinical expertise and patient and family preferences and values for the delivery of optimal health care and system effectiveness. + Safety: The nurse minimizes risk of harm to patients, families, providers, and self through system effectiveness and individual performance. Professionalism: The nurse demonstrates a commitment to the nursing profession through lifelong learning, adherence to ANA's Code of Ethics for Nurses, participation in a professional organization, and advancing community outreach. + Person and Family-Centered Care: The nurse recognizes the patient (or the patient's designee) as the source of control and a full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs. + Leadership: The nurse effectively collaborates and applies innovative, systems thinking to engage in systematic, evidence-based problem solving and decision making to promote effective changes within a complex care delivery system supporting the vision of Penn Medicine. Informatics/Technology: The nurse utilizes appropriate information and technology to communicate, manage knowledge, mitigate error, and support decision-making across the continuum. + Teamwork: The nurse effectively engages in the process of cooperation, coordination, and collaboration in an effort to provide safe, quality outcomes for patients within inter and intra-professional teams, including virtual teams. + Continuous Quality Improvement (CQI): The nurse utilizes data and QI methods to identify potential and actual problems and opportunities to provide care that is safe, timely, efficient, effective, and equitable. Credentials: + Basic Cardiac Life Support (Required) + Basic Cardiac Life Support BLS/ACLS/PALS (per specialty) + Registered Nurse - PA (Required) + Registered Nurse with State Licensure Education or Equivalent Experience: + Bachelor of Science Nursing (Required) + Bachelor's Degree-BSN from an accredited school of nursing and up to 15 months of nursing experience. We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. Live Your Life's Work We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law. REQNUMBER: 282424

Malvern Behavioral Health is currently seeking a full time Utilization Management Coordinator for our new Acute Inpatient units location in South Philadelphia! This position is a full time, benefit eligible position! To conduct continued stay reviews of medical record documentation using pre-established criteria and to provide updated progress reports to third party payers in order to receive certification for payment. This individual will perform all utilization reviews for acute psychiatric and residential drug and alcohol clients. Summary of Essential Position Functions: Maintains accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized and authorization numbers. Coordinates reviews, appeals and maintains denial logs. Performs concurrent continued stay reviews using pre-established criteria. Understands Medical Necessity and ASAM criteria and communicates this information accurately to insurance carriers. Consults with appropriate treatment team members for clarification of documentation as needed. Exchanges information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals. Inputs data accurately for financial purposes. Maintains accurate review sheets of all reviews performed. Assists supervisor and departments in identifying patterns of mis-utilization. Responds to telephone messages quickly, professionally and appropriately. Participates in continuing education to reach professional growth objectives, including maintenance of own credentials, certifications and participating in committees. Attendance at case conference for clinical updates. Maintains and communicates authorization information to all team members. Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required. Educates new staff members about Medical Necessity criteria, high-quality documentation and insurance needs. Develops relationship and rapport with payers and third party insurance reviewers Initiates and follows the precertification and/or single case agreement process as necessary. Supervisory Responsibilities: None Benefits This position is a full time, benefit eligible position. Benefits offered include, but not limited to: Medical Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off 401K plan with company match Qualifications Qualifications: To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. This position requires individuals that are client focused; team oriented; great interpersonal and communication skills; flexible to sudden changes in workload, emergency or staffing; dependable; problem solving skills; focused on compliance and performance quality. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience: Education and/or Experience: Master's Degree or graduate of an accredited nursing program with licensure in the state of Pennsylvania. Previous utilization review experience preferred. Technical/Computer Skills: Microsoft office and billing experience preferred. Requires much independent action and decision making and ability to organize own work. Knowledge of facility systems and organization as they pertain to medical records and organization review. Knowledge of medical terminology, medical record format and content. Work Environment and Hazards: Risk of exposure to communicable disease. Possible exposure to intoxicated, disruptive, and/or agitated patients. Protected from weather conditions. Physical Requirements: Sedentary work primarily - lifting 10 lbs. maximum *Malvern Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.*

Full-time Description The Renfrew Center of Philadelphia, offers an unmatched opportunity, in the field of eating disorders, for a Utilization Review Coordinator to work in an environment that changes lives. The Renfrew Center has opportunities for individuals of all backgrounds, that have the desire and passion to foster a positive outcome and impact on our patients' lives. The Renfrew Center's research-based treatment model, for eating disorders, is focused on treating the whole person and helping them lead a rich and fulfilling life. Our commitment to you - We are committed to providing every employee the opportunity for personal and professional development through: 401(k) with company match Healthcare benefits Vacation and sick days Employee referral program Employee discounts to various stores, amusement parks, events, etc. Continuing education (CE) programs and training Advancement opportunities within the organization Position Responsibilities: Complete daily treatment pre-certifications with insurance/managed care companies. Complete daily concurrent reviews with insurance/managed care companies. Understand and present acuity, rationale for continued stay, treatment goals and discharge criteria from a medical record. Be familiar with various managed care companies medical necessity criterion and appropriate application, to guide the concurrent review process. Maintain accurate and complete documentation, including computer documentation. Participate and effectively collaborate with a treatment team as an active team member. Demonstrate an understanding of the functional/developmental age of the individual served. Requirements Education, Competencies and Credentials: Master's degree in Human Services, Psychology, or Social Work required. A minimum of 1-2 years of training/working in a residential or health care facility is required. Previous experience working with eating-disorder patients is highly preferred. Familiarity with psychiatric disorders is required. Hours: 40 hours per week, Monday through Friday. The Renfrew Center provides women with the tools they need to succeed - in recovery and life. Offering a warm, nurturing environment, Renfrew emphasizes respect for the unique psychology of women, the importance of a collaborative, therapeutic relationship, and the belief that every woman needs to actively participate in her growth and recovery. The Renfrew Center - An Equal Employment Opportunity Employer, devoted to diversity, equity, and inclusion.

Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus

The AOT Outreach Nurse Coordinator works closely with medical and program leadership. Supporting the liver and kidney transplant programs by coordinating the delivery of care for the transplant patients in the satellite clinics throughout the Temple service area. Serves as a liaison between Temple University Hospital and our partner organizations to improve the delivery of care. Under the direction of the Director Clinical Transplant Services, partners with the QAPI team to develop and report on quality improvement projects related to Temple's AOT satellite clinics. Supports the outreach and education coordinator as needed to provide clinical support for dialysis center visits. Demonstrates a thorough knowledge of nursing theory and practice involved in providing nursing care. Familiarity with organization and function of departments, policies, procedures and regulations. Orchestrates the care of patients with end stage organ disease. This position requires regular travel between Temple University Hospital and Satellite locations. Education Bachelor's Degree in Nursing from an accredited Nursing program. Required Master's Degree in Nursing from an accredited Nursing program. Preferred Experience 3 years experience in nursing. Required General Experience and knowledge of Electronic Medical Record. Required General Experience in a Transplant program. Preferred Licenses PA Registered Nurse License Required Multi State Compact RN License Required Or '394677

Monarch/Brandywine Senior Living Company Culture and Values: At Monarch Communities, we value compassion, innovation, and community. Our team is committed to making a meaningful impact on the lives of our residents and fostering a collaborative and supportive work environment. Job Description Salary: $32.00 - $34.00 Hourly Have you cared for others most of your life and decided to make a career out of your natural talent? Do you gain great satisfaction from your ability to calm others and triage a situation or ailment? If this sounds like you - then you have found the best employer who will appreciate your work as a Licensed Practical Nurse! What will you get to do as an LPN? Provide warm and engaging personal care services, assistance, support, and companionship. Administer or assist with medication for residents according to the Resident Care Plan. Engage residents while checking on their well-being and communicate changes in condition or Care Plan. Inspire your team and collaborate with the Wellness Director and Assistant Wellness Director in assessing and documenting resident assessments at state or Retirement Unlimited specified intervals. Why we want you on our team: You have a positive attitude and love working with people! A graduate of a state approved school of nursing. A current state license as a Licensed Practical or Vocational Nurse. No experience needed! We welcome new grads and experienced nurses! What can our community offer you? Pleasant Teamwork Environment Hands-On Immersive Training and Learning experiences. Resort-style Community Supportive Corporate Team Referral Bonus Program Free Meal Daily Competitive Wages Many Opportunities for Growth and Development Being a community team member means having the opportunity to be something more than an employee. It is an opportunity to serve and work with vision, meaning, and purpose. At our community you can both grow as a person and in your career. Great opportunities await! Part Time Schedules: (3:00pm-11:00pm) Week1 - Sunday, Monday / Week 2 - Monday, Saturday (7:00am-3:00pm) Week 1 - Sunday/ Week 2- Saturday (3:00pm-11:00pm) Week 1- Saturday/ Week 2- Sunday (7:30am-11:30am) Week 1 Monday,Tuesday,Thursday,Saturday/ Week 2 Sunday, Monday, Tuesday,Thursday Qualifications Graduation from an accredited School of Nursing, with current LPN license At least 2 years' experience with long-term care, assisted living, home health or hospital setting preferred Experience working with residents with Alzheimer's or other related dementias Ability to handle multiple tasks Knowledge of federal and state regulations, and of nursing practices, techniques and methods applied to health and wellness resident Proficiency in computer skills, Microsoft Office (Windows, Outlook, Excel) with the ability to learn new applications While performing the duties of this job, the associate is often required to stand, walk, sit, use fine and gross motor skills, reach with hands and arms, balance, stoop, kneel, crouch, talk, hear, and smell. An individual in this position will be required to lift or carry weight in up to 50 lbs. Intermittent physical activity includes lifting and supporting residents. The associate must use proper body mechanics. Additional Information Benefits Offered (for Part-Time Employees): Paid Time Off (PTO) Flexible Schedule On the job training Employee Assistance Program (EAP) Free Parking Other Compensation Programs: Employee Referral Bonus Resident Referral Bonus Equal Opportunity Statement: Monarch Communities and Brandywine Senior Living is an Equal Opportunity Employer. We comply with all applicable federal, state, and local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees.