Utilization review nurse jobs in Lower Makefield, PA - 277 jobs

Job DescriptionDescription: Job Role Clinical care (UM) nurses coordinate overall member care, from pre-admission, continued stay (concurrent review) and any outpatient services utilizing a pro-active, evidence-based decision-making process that is physician sensitive and attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for admissions, lengths of stay and a facilitator for discharge planning. This position functions as a liaison between the providers, hospitals and health plans. Responsible for the implementation of client-specific contracted polices, managed care policies and must be very knowledgeable about benefits, criteria and guidelines used for reviews. Must be adept at identifying and referring potential quality of care issues to the Medical Director, client and/or appropriate staff. Requirements: Responsibilities: Initiating the continuum of care process for neonatal admissions. Interacting telephonically and in writing with hospital staff to collect clinical information for newborns in intensive care nurseries in order to facilitate medical necessity determinations. Coordinating discharge planning needs for newborns being discharged from intensive care nurseries. Authorization of all services requiring prior authorization, based upon health plan specific service agreements. Review of all services (readmissions and elective procedures) for first year of life. Documenting all activities in the electronic medical record. May include evening and/or weekend on call. Qualifications Registered Nurse (RN) with a current, unrestricted license is required Three or more years of clinical experience as a nurse in a Level III or Level IV NICU is required. Three or more years of experience working in a concurrent review or discharge planning role within a health plan or an acute facility is strongly preferred. Must be willing to provide weekend and holiday coverage occasionally. Experience with Interqual and/or MCG is preferred. Experience with URAC and/or NCQA standards is preferred. Experience with data entry into a database or EHR required. Must have strong computer skills. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks. Must demonstrate accuracy in spelling and documentation. Ability to perform job functions with autonomy and be a self-starter. Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times. Must have commitment to excellence in customer service. Benefits Some of the benefits we offer our team are: Paid Time Off Paid Parental Leave Medical, dental, vision benefits 401K with company match Short- and Long-Term Disability Group Life Insurance Tuition reimbursement Professional development opportunities Business Casual work environment ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: ************************* Equal Opportunity Employer, including individuals with disabilities and veterans.

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.

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.

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

**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 *************************************************************

Clinical Document-Coding Mgmt Saint Peter's is among the few hospitals in the world to have earned its 7th consecutive Magnet designation and its first Magnet with Distinction designation. The Magnet with Distinction designation is an elite level of this recognition, awarded to organizations that demonstrate exceptional performance in nursing practices and patient outcomes. Our team of award-winning nurses is growing, and we are looking for talented, compassionate RNs to join our team. The Utilization Review RN Per Diem will: * Identify appropriate medical information necessary to certify and/or refer cases on admission and on continued stay reviews. * The review of the medical record includes all pertinent information required by insurance payers including the reason for admission, current symptoms, abnormal lab values, abnormal diagnostics, outpatient condition prior to an admission and response or lack of response to such treatment. Review medication administration record to identify antibiotics administered, dose and frequency, respiratory treatments, medical/surgical and social history. Documentation if discharged from a hospital within 30 days, as well as any pertinent clinical information. * Performs assigned admission reviews within established time frame in accordance with payer requirements as well as daily reviews for Medicare, Medicaid and managed care companies per their requirements. * Ensures timely provision of clinical review information to payer as evidenced by no denials for lack of clinical information. Collaborates with patient registration /resource services for issues related to insurance coverage (i.e., correct insurance is not in patient record. * Whenever possible, manages requests for concurrent reconsiderations as evidenced by the "overturn" of the initial denial decision. * Initiates collaboration with the Medical Staff or Clinical Documentation Specialists by identifying additional clinical information required for obtaining payer determination for approval of the admission. * Identifies hospital stays at risk for admission downgrades or denials and involves the Physician Advisor in a timely fashion when assistance is needed. * Refers cases to the Physician Advisor when a change in level of care or termination of benefits seems applicable based upon criteria for Medicare/Medicaid patients (i.e., certification of acute days versus custodial or SNF). * Utilizes case management software including utilization criteria guidelines, to capture essential admission clinical review documentation. Requirements: * Registered nurse currently licensed to practice in the State of New Jersey. * Required to have three (3) to five (5) years-nursing experience working in an acute care hospital setting, preferably medical/surgical or critical care. * Experience should include assessment of a patient's diagnosis, prognosis, care needs responsible for a patient admission. * The ability to clinically assess the patient condition for establishing medical necessity justifying an inpatient admission by analyzing medical records, interpreting clinical and laboratory data. * Must have excellent interpersonal, communication, organizational and computer skills. * Flexible and able to work independently and part of a team. Salary Range: 51.00 - 51.00 USD We offer competitive base rates that are determined by many factors, including job-related work experience, internal equity, and industry-specific market data. In addition to base salary, some positions may be eligible for clinical certification pay and shift differentials. The salary range listed for exempt positions reflects full-time compensation and will be prorated based on employment status. Saint Peter's offers a robust benefits program to eligible employees that will support you and your family in working toward achieving and maintaining secure, healthy lives now and into the future. Benefits include medical, dental, and vision insurance; savings accounts, voluntary benefits, wellness programs and discounts, paid life insurance, generous 401(k) match, adoption assistance, back-up daycare, free onsite parking, and recognition rewards. You can take your career to the next level by participating in either a fully paid tuition program or our generous tuition assistance program. Learn more about our benefits by visiting our site at Saint Peter's.

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.

**his position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.** **Responsibilities:** 1. Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. 2. Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided. 3. Coordinates and assists in implementation of plan for members. 4. Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. 5. Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care. 6. Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. 7. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. 8. Encourages member participation and compliance in the case/disease management program efforts. 9. Documents accurately and comprehensively based on the standards of practice and current organization policies. 10. Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care. 11. Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes. 12. Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes. 13. Completes other assigned functions as requested by management. Core Individual Contributor Competencies. Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus, Accountable, Learn, Communicate. **Qualifications:** **Education/Experience** 1. Requires an associate's or bachelor's degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school. 2. Requires a minimum of two (2) years clinical experience. **Additional licensing, certifications, registrations:** 1. Requires an active New Jersey Registered Nurse License. **Knowledge:** - Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications. - Prefers working knowledge of case/care management principles. - Prefers working knowledge of principles of utilization management. - Prefers basic knowledge of health care contracts and benefit eligibility requirements. - Prefers knowledge of hospital structures and payment systems. **Skills and Abilities:** - Analytical - Compassion - Interpersonal & Client Relationship Skills - Judgment - Listening - Planning/Priority Setting - Problem Solving - Team Player - Time Management - Written/Oral Communication & Organizational Skills **About US Tech Solutions:** US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit *********************** (********************************** . US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $39.40 - $59.19 Scheduled Weekly Hours: 40 Position Overview Performs chart review of identified patients to identify quality, timeliness and appropriateness of patient care. Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self pay patients, based on appropriate guidelines. Uses these criteria guidelines to screen for appropriateness for inpatient level of care or observation services based on physician certification (physicians H&P, treatment plan, potential risks and basis for expectation of a 2 midnight stay). Refers cases as appropriate, to the UR physician advisor for review and determination. Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis. Performs concurrent and retrospective clinical reviews with various payers, utilizing the appropriate guidelines as demonstrated by compliance with all applicable regulations, policies and timelines. Adheres to CMS guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee. Identifies, develops and implements strategies to reduce length of stay and resource consumption. . Confers proactively with admitting physician to provide coaching on accurate level of care determinations at point of hospital entry. Keeps current on all regulatory changes that affect delivery or reimbursement of acute care services. Uses knowledge of national and local coverage determinations to appropriately advise physicians. Understands and applies federal law regarding the use of Hospital Initiated Notice of Non-Coverage (HINN) and Lifetime Reserve Days letters. Identifies and records consistently any information on any progression of care or patient flow barriers using the Avoidable Days tool in the Utilization software program. Consults with medical staff, care team and case managers as necessary to resolve immediate progression of care barriers through appropriate administrative and medical channels. Engages care team colleagues in collaborative problem solving regarding appropriate utilization of resources. Recognizes and responds appropriately to patient safety and risk factors. Represents Utilization Management at various committees, professional organizations an physician groups as needed. Promotes the use of evidence based protocols and or order sets to influence high quality and cost effective care. Identifies, develops and implements strategies to reduce lengths of stay and resource consumption in the patient population. Participates in performance improvement activities. Promotes medical documentation that accurately reflects findings and interventions, presence of complication or comorbidities, and patient's need for continued stay. Identifies and records episodes of preventable delays or avoidable days due to failure of progression of care processes. Maintains appropriate documentation in the Utilization software system on each patient to include specific information of all resource utilization activities. Participates actively in daily huddles, patient care conferences, and hospitalist or nurse handoff reports to maintain knowledge about intensity of services and the progression of care. Identifies potentially wasteful or misused resources and recommends alternatives if appropriate by analyzing clinical protocols. Maintains related continuing education credits = 15 per calendar year. MINIMUM REQUIREMENTS Education: Minimum of Associate's degree in Nursing. Graduate of an accredited school of nursing. CPHQ, CCM or CPUR preferred. Experience: Three years of clinical nursing or two years quality management, utilization review or discharge planning experience. Other Credentials: Registered Nurse - NJ Knowledge and Skills: Three years of clinical nursing or two years quality management, utilization review or discharge planning experience. CPHQ, CCM or CPUR preferred. Special Training: Basic computer skills including the working knowledge of Microsoft Office, UR software and EMR. Possesses familiarity with MCG guidelines. Mental, Behavioral and Emotional Abilities: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Usual Work Day: 8 Hours PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Sitting , Standing , Walking Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Keyboard use/repetitive motion , Talk or Hear Continuous physical demands include: Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 5 lbs. Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: N/A This position is eligible for the following benefits: Medical Plan Prescription drug coverage & In-House Employee Pharmacy Dental Plan Vision Plan Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA Retirement Savings and Investment Plan Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Supplemental Group Term Life & Accidental Death & Dismemberment Insurance Disability Benefits - Long Term Disability (LTD) Disability Benefits - Short Term Disability (STD) Employee Assistance Program Commuter Transit Commuter Parking Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child Voluntary Legal Services Voluntary Accident, Critical Illness and Hospital Indemnity Insurance Voluntary Identity Theft Insurance Voluntary Pet Insurance Paid Time-Off Program The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.

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 Led by the community's Health and Wellness Director (RN), our Wellness Nurse is a Licensed Practical Nurse (LPN) who provides direct nursing care to the Residents with an emphasis on holistic wellness. They also help supervise the day-to-day nursing activities performed by care staff of Certified Nursing Assistants. Schedule: The Wellness Nurse (LPN) is full-time (at least 30 hours per week) 3pm - 11pm and/or part-time (22-29 hours per week) 3pm - 11pm including every other weekend. Salary Range: $34.00 - $36.00 Hourly Responsibilities and Duties Monitors the health, safety, and well-being of all residents Assisting in training and monitoring of medication administration Supervise care staff in accordance with current state regulations and community policies Maintaining clinical quality assurance in accordance with federal, state and local standards Promote the highest degree of service to our residents while leading and demonstrating the mission of the company Conduct thorough resident assessments 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 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.

About us At Cooper University Health Care , our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development. Discover why Cooper University Health Care is the employer of choice in South Jersey. Short Description Supports, educates, and assists patients and their families, serving as a link to their doctors and supportive services. This position's role is key in the implementation of multi-disciplinary care pertaining to Anticoagulation and warfarin maintenance. Supports, educates and assists patients and their families, serves as a patient advocate. 25% Demonstrates effective teamwork as a member of the interdisciplinary care team, fostering and exemplifying a culture of respect. 25% Responsible for the coordination of care of warfarin, assists in securing prescriptions and supplies for proper care. Participates in telephone triage 25% Consistently follows evidence based practice and nursing standards/procedures to provide nursing care that eliminates preventable events of patient harm and promotes excellent patient outcomes. 25% Cardiac experienced preferred Anticoagulation/Warfarin Management preferred Education Requirements Current NJ-RN License, BSN required. License/Certification Requirements Current NJ-RN License (Registered Nurse) Current American Heart Association BLS Certification (Basic Life Support for Health Care Providers);

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.

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

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. 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/Disabled An 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. 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

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 Led by the community's Health and Wellness Director (RN), our Wellness Nurse is a Licensed Practical Nurse (LPN) who provides direct nursing care to the Residents with an emphasis on holistic wellness. They also help supervise the day-to-day nursing activities performed by care staff of Certified Nursing Assistants. Schedule: The Wellness Nurse (LPN) is a full-time (at least 30 hours per week) and/or part-time (22-29 hours per week) or Per-Diem non-exempt, position that will be scheduled weekdays and alternating weekends. All Shifts Available. Salary Range: $35.00 - $35.10 Hourly Responsibilities and Duties Monitors the health, safety, and well-being of all residents Assisting in training and monitoring of medication administration Supervise care staff in accordance with current state regulations and community policies Maintaining clinical quality assurance in accordance with federal, state and local standards Promote the highest degree of service to our residents while leading and demonstrating the mission of the company Conduct thorough resident assessments 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 Benefits Offered (for Part-Time Employees): Paid Time Off (PTO) and Holidays Flexible Schedule On the job training Employee Assistance Program (EAP) Free Parking Other Compensation Programs: Employee Referral Bonus Resident Referral Bonus Benefits Offered (Per Diem Employees): Flexible Schedule On the job training Free Parking 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.