Utilization review nurse jobs in Pennsylvania - 973 jobs

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 in the Department of Psychiatry Partners with providers in the care of patients seeking psychiatric, mental health, and behavioral health services Provides clinical advice to patient via the telephone and patient portal Responsible for indirect patient care such as medication refills and prior authorizations Experience Required 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, 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% Experience in psychiatric nursing, mental health, or behavioral health services strongly preferred. Education Requirements NJ BSN Required License/Certification Requirements Current NJ-RN License (Registered Nurse) Current American Heart Association BLS Certification (Basic Life Support for Health Care Providers);

Nurse Reviewer PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely. Essential Duties and Responsibilities: Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Healthcare Quality Strategies, Inc. 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 position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply via the HQSI Careers Page at: ************ > Careers > Current Employment Opportunities EOE: Minorities/Females/Disabled/Veterans Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace Healthcare Quality Strategies, Inc. is an E-Verify Employer

About us: Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ "Superior" by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! * Competitive compensation * Healthcare benefits package that begins on first day of employment * 401K retirement plan with company match * Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays * Up to 6 weeks of parental and bonding leave * Hybrid work schedule (3 days in the office, 2 days from home) * Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) * Tuition reimbursement after 6 months of employment * Numerous opportunities for continued training and career advancement * And much more! Responsibilities The Utilization Review Nurse's duties will include, but are not limited to: * Support internal claims adjusting staff in the review of workers' compensation claims * Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone * Meet required decision-making timeframes * Clearly document all communication and decision-making within our insurance software system * Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys * Utilize good clinical judgment, careful listening, and critical thinking and assessment skills * Track ongoing status of all UR activity so that appropriate turn-around times are met * Maintain organized files containing clinical documentation of interactions with all parties of every claim * Send appropriate letters on each completed UR Qualifications * Active Licensed Practical Nurse and/or Registered Nurse License * 1+ years of utilization review experience at a managed care plan or provider organization * 2 + years' clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review * Excellent oral and written communication skills, including outstanding phone presence * Strong interpersonal and conflict resolution skills * Experience in a fast-paced, multi-faceted environment * The ability to set priorities and work both autonomously and as a team member * Well-developed time-management and organization skills * Excellent analytical skills * Working knowledge of: Microsoft Word, Excel, and Outlook

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

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.

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

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.

Using a person-centered approach, the LPN works collaboratively within a team to maintain and provide health care for individuals in Residential Group Homes. You will help ensure that individuals with intellectual, developmental, and physical disabilities receive the highest quality care while actively participating in the development of their personal service plans. What You'll Do As part of an interdisciplinary team, you will: Coordinate, follow up, and maintain health care services for assigned clients Develop, implement, and continuously review individualized healthcare plans Maintain comprehensive medical records and documentation Transcribe and communicate physician orders and ensure appropriate follow-up and referrals Communicate significant changes in a client's condition, upcoming procedures, medication requests, injuries, or ER visits to directors, staff, and families Interact with doctors' offices, hospitals, pharmacies, and other medical providers Manage all medical appointments, including annual physicals, ensuring timeliness and regulatory compliance Coordinates with the contracted pharmacy all issues regarding medication ordering, reordering, prior authorizations, Medication Administration Record reviews, etc. Maintains medication regimen to ensure the safe and effective use of medications. Complete lifetime medical histories and pertinent information for physicians Visit assigned homes as needed; check on individuals or staff training completion Maintain a thorough working knowledge of all applicable agency and regulatory policies, procedures, and practices Ensure compliance with laws and 6400 regulations Attend required in-service training Participate in a rotating on-call schedule, which may include nights, weekends, and holidays, for processing after-hour orders through eMAR What You'll Bring A commitment to promoting dignity, respect, and independence for all individuals Patience and empathy in working with individuals of diverse backgrounds and needs Strong communication skills to collaborate with team members, individuals, and families A desire to learn, grow, and make a meaningful difference in someone's life What You'll Have Nursing license in the State of Pennsylvania and qualified to pass medications One year of clinical experience or other appropriate experience Experience working with intellectually disabled adults is helpful, but not mandatory Certification in CPR for health professionals Valid driver's license with access to a reliable vehicle, proof of insurance, and registration Eligibility for State Police Criminal Record Check and Child Abuse History Clearance FBI clearance required for individuals who do not meet PA residency requirement

←Back to all jobs at Friendship Community Nursing Consultant Friendship Community is an EEO Employer - M/F/Disability/Protected Veteran Status Join our nursing consultant team at Friendship Community and work with an interdisciplinary team to provide medical support for meeting the health care needs of adults with IDD/DD in residential group homes. Be involved with medication administration training, communication of Individuals' medical status, and other medical tasks for the health and wellness of Individuals. This is not your typical shift work. Proficiency in Microsoft Office is required. Current PA nursing license required, RN or LPN. At least 1 year of experience with IDD/DD population preferred, but not required. Schedule is primarily daytime Monday-Friday, with occasional evenings or weekend hours to monitor medication administration or provide phone support. Please visit our careers page to see more job opportunities.

This full time position offers a wealth of benefits to include comprehensive and affordable health benefits , paid parental leave , generous paid time off , tuition and student loan assistance , employer retirement contributions , and much more! There is a $1,000 sign-on bonus for this position! Essential Job Functions Assesses, documents, and ensures follow-up on all aspects of the health care for assigned adult individuals and medically complex children. Ensures routine monitoring and clinical assessments of the health and safety of assigned medically complex children. Documentation of these assessments are thoroughly completed in our Electronic Record Medical system Point-Click-Care (PCC). Effectively communicates clinical assessment information to medical professionals, family members, advocates, and internal team members. Collaborates with physicians, Life Sharing families, internal team members, and other health care disciplines to identify and evaluate the health needs of assigned adult individuals and medically complex children. Assesses minor injuries and evaluates for illnesses, as needed. Works with Life Sharing Providers the Life Sharing Program Coordinators to ensure access to medical care for assigned adult individuals and medical complex children. Accompanies and/or transports assigned adult individuals and medically complex children to medical appointments, as needed. Completes follow-up with physicians and Life Sharing families upon an adult individual or child's discharge from the Emergency Room or Hospital, as needed. Ensures needed medications, supplies, and equipment are available to assigned Life Sharing families, as needed. Administers and documents the administration of all medications, treatments, and therapies as ordered by prescribing physician, as needed. Provides support and relevant medical/safety training to Life Sharing families and internal staff regarding current and new diagnoses, medications, medication side effects, as well as the health care needs of children and adult individuals, as needed. Consults with the Life Sharing Providers of assigned medically complex children regarding medical concerns, and responds to the home to assist with care, as needed. Creates, updates, and maintains Lifetime Medical Histories (LMH) in accordance with the 6500 regulations, prior to the annual Individual Support Planning (ISP) meeting for assigned individuals. Participates in annual Individualized Support Planning (ISP) meetings for individuals as needed. Ensures Individualized Support Plan (ISP)/ LMH and Annual Physical examination diagnosis match and remain current. Participates in HRST process: completes Clinical Reviewer responsibilities, documents and maintains records in Point-Click-Care (PCC). Reviews medication logs for assigned caseload on a monthly basis and provides feedback to the individual's assigned Life Sharing Program Coordinator, if necessary. Reviews Self Medication Assessments for adult individuals capable of taking their own medications. Maintains medical charts of the individuals served in the Life Sharing program to ensure regulatory compliance. Communicates medical appointment needs to the appropriate Life Sharing Program Coordinator. Takes an active interest in promoting and protecting the human and civil rights of the individuals served. Maintains and promotes a positive work atmosphere in accordance with our Core Values, by behaving and communicating in a professional manner at all times in the presence of individuals, co-workers, supervisors and external stakeholders. Responsible for additional duties as directed by the Administrator and the Clinical Coordinator of the Life Sharing Program. Knowledge/Skills/Abilities To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. 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. Registered Nurse (RN) in the state of Pennsylvania with three (3) years of experience working with people with Intellectual and/or Developmental Disabilities, or a Licensed Practical Nurse (LPN) in the state of Pennsylvania with at least five (5) years of experience working with people with Intellectual and/or Developmental Disabilities. Experience with Electronic Medical Record (EMR) systems is preferred. Must have the ability to communicate effectively in English, both written and oral. Must be detail oriented, have good problem solving skills, organizational skills, and must have exceptional interpersonal and communication skills. Ability to successfully pass and maintain acceptable background checks - FBI, PA Child Abuse, and PA State Police Criminal History. A valid US Driver's License is required. Attaining approved driver status for the organization is required. Supervisory Responsibilities: This position does not include any direct supervisory responsibilities. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form; ability to deal with problems involving several concrete variables in standardized situations. Computer Skills: Working knowledge of computers and be willing to learn the software programs used by the State and other governing agencies (e.g. HCSIS, Enterprise Incident Management System) and other internal systems. Must be proficient in Windows Operating Systems and Microsoft Office applications (e.g. Outlook, Word, Excel, PowerPoint, etc.) Work Environment: While performing the duties of this job, the employee will be required to work in a variety of settings and environments and has a low exposure risk to adverse weather conditions. The noise level in the work environment is usually moderate. In the event that unanticipated aggressive behavior manifests from individuals served and de-escalation techniques fail, physical crisis intervention may be required. Must be available to work flexible hours and is expected to come in at various times depending upon work-load and business needs. Physical Demands: The employee must regularly lift and /or move up to 10 pounds, occasionally lift and/or move up to 50 pounds and rarely lift and/or move more than 100 pounds with assistance. Specific vision abilities required by this job include Close vision, Distance vision, Peripheral vision, Depth perception and Ability to adjust focus. While performing the duties of this job, the employee is regularly required to stand for long periods of time; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to walk and sit. Hazards: While performing the duties of this job, the employee may face low exposure risks to blood borne pathogens, with a low exposure risk to hazardous materials. *Salary starts at $80,000 - $84,000 based on nursing credentials* **Equal Opportunity Employer M / F / D / V **

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);

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

Nurse Reviewer PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely. Essential Duties and Responsibilities: Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Healthcare Quality Strategies, Inc. 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 position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply via the HQSI Careers Page at: ************ > Careers > Current Employment Opportunities EOE: Minorities/Females/Disabled/Veterans Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace Healthcare Quality Strategies, Inc. is an E-Verify Employer

Homewood Living Martinsburg A variety of soft skills and experience may be required for the following role Please ensure you check the overview below carefully. Shift: Night Shift Status: Part-Time Salary: 25.7 Hourly Our Mission Statement Honor Christ through faithful service to seniors and one another. Our Community We have grown from humble beginnings in 1932, from serving 12 residents in one small house in Hagerstown, MD to serving over 2,200 individuals and employing over 1,300 co-workers at five different locations in MD and PA. Our co-workers' dedication, skills, loyalty, and compassion have been the key to Homewood's success. At Homewood, you'll become part of a professional and compassionate team, united by a shared commitment to excellence in care and genuine community connection. What's in it for you? As a valued member of our team, you'll enjoy these exceptional benefits & perks: Paid time off, with an opportunity to cash out each year Assistance for new LPNs/RNs - we pay up to 50% of your student loans Shift and weekend differentials But that's not all! Our comprehensive benefits package also includes: Referral bonus of up to $600 Tuition reimbursement Health, dental, vision, and life insurance options Retirement contributions Professional licensure reimbursement Want to know more? Visit Homewood Benefits for all the details. Job Summary: Assesses the direct delivery of resident care and administers prescribed medications. Essential Functions: Treats all information about residents, their condition, and family as well as personnel matters as confidential information.Complies with established Corporate and Departmental policies and procedures, and maintains established standards and practices.Administers prescribed medications and treatments in accordance with approved nursing techniques.Provides accurate and descriptive records of medical and nursing care of the residents.Assigns daily resident care duties to Nursing Assistants and Hospitality Aides, monitors and evaluates the delivery of care.Accurately transcribes and carries out all physicians orders and assists with physician visits.Participates in resident care planning.Evaluates and is alert to the physical and psychological needs of the residents and responds in accordance with proper nursing techniques and protocol.Assists with admissions and discharges of residents.Assists in the management of Nursing Assistants and Hospitality Aides.Assists with direct resident care as time and responsibilities permit.Assists with carrying out physician orders.Performs other functions as directed by the supervisor. Qualifications: Current and valid LPN license in the state providing nursing care.Possesses judgment capabilities, initiative and dependability.Ability to read, write and understand English well.Ability to stand, walk, stoop, twist and turn frequently throughout the course of an eight hour shift.Ability to lift 30 pounds in assisting co-workers with resident lifts, transfers, etc. several times throughout the shift. Standing and walking distances constantly throughout the campus would be required during the shift in evaluating residents and supporting line staff and (at applicable facilities) respond to emergency needs of the Retirement Community.Ability to push a med cart in dispensing medications.Must be able to react quickly and decisively in emergencies and in unexpected behavior of residents.Ability to understand and follow oral and written instructions.Ability to communicate to residents at a level they can understand. Physical Requirements: Ability to stand, walk, stoop, twist and turn frequently throughout the course of an 8 hour shift. Ability to push a med cart in dispensing medications. Ability to lift 30 pounds in assisting co-workers with resident lifts, transfers, etc. several times throughout the shift. xevrcyc Must be able to react quickly and decisively in emergencies and in unexpected behavior of residents.

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.

SummaryUsing a person-centered approach, the LPN works collaboratively within a team to maintain and provide health care for individuals in Residential Group Homes. You will help ensure that individuals with intellectual, developmental, and physical disabilities receive the highest quality care while actively participating in the development of their personal service plans. What You'll Do:As part of an interdisciplinary team, you will:Coordinate, follow up, and maintain health care services for assigned clients Develop, implement, and continuously review individualized healthcare plans Maintain comprehensive medical records and documentation Transcribe and communicate physician orders and ensure appropriate follow-up and referrals Communicate significant changes in a client's condition, upcoming procedures, medication requests, injuries, or ER visits to directors, staff, and families Interact with doctors' offices, hospitals, pharmacies, and other medical providers Manage all medical appointments, including annual physicals, ensuring timeliness and regulatory compliance Coordinates with the contracted pharmacy all issues regarding medication ordering, reordering, prior authorizations, Medication Administration Record reviews, etc. Maintains medication regimen to ensure the safe and effective use of medications. Complete lifetime medical histories and pertinent information for physicians Visit assigned homes as needed; check on individuals or staff training completion Maintain a thorough working knowledge of all applicable agency and regulatory policies, procedures, and practices Ensure compliance with laws and 6400 regulations Attend required in-service training Participate in a rotating on-call schedule, which may include nights, weekends, and holidays, for processing after-hour orders through eMARWhat You'll Bring:A commitment to promoting dignity, respect, and independence for all individuals Patience and empathy in working with individuals of diverse backgrounds and needs Strong communication skills to collaborate with team members, individuals, and familiesA desire to learn, grow, and make a meaningful difference in someone's life What You'll Have:Nursing license in the State of Pennsylvania and qualified to pass medications One year of clinical experience or other appropriate experience Experience working with intellectually disabled adults is helpful, but not mandatory Certification in CPR for health professionals Valid driver's license with access to a reliable vehicle, proof of insurance, and registration Eligibility for State Police Criminal Record Check and Child Abuse History ClearanceFBI clearance required for individuals who do not meet PA residency requirement Perks with a Purpose Our benefits are created with YOU in mind. Healthcare • Highmark Medical and Mental Health • Delta Dental and Davis Vision Coverage • Health Savings Account/Flexible Spending Accounts • Teladoc Virtual Health Financial Well-being • 401K Retirement Plan with Employer Match • On-Demand Pay • Employee Referral Bonus Program • Student Loan Forgiveness • College Scholarship & Tuition Discounts • Employee Discounts Life & Family Support • Company Paid Life Insurance • Short & Long-Term Disability Insurance • Employee Assistance Program • Erie Campus*- discounted on-site weekday childcare • Employee discounts for select BNI events and services • Generous Paid Time Off • Seven Paid HolidaysWho is Barber National Institute?The Barber National Institute is a non-profit committed to its mission of providing the highest quality services for children and adults with autism, intellectual disabilities or behavioral health challenges and their families. Since our founding in 1952, we have evolved into a multi-faceted organization serving more than 6,200 individuals annually with a wide range of educational, vocational, residential and behavioral health programs. We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, ancestry, age, sexual orientation, protected veteran status, disability or any other legally protected status. If you need an accommodation to apply, please contact HR. EOEAny consideration of the background check will be an individualized assessment based on the applicant or employee's specific record and the duties and requirements of the specific job.

←Back to all jobs at Friendship Community Nursing Consultant Friendship Community is an EEO Employer - M/F/Disability/Protected Veteran Status Join our nursing consultant team at Friendship Community and work with an interdisciplinary team to provide medical support for meeting the health care needs of adults with IDD/DD in residential group homes. Be involved with medication administration training, communication of Individuals' medical status, and other medical tasks for the health and wellness of Individuals. This is not your typical shift work. Proficiency in Microsoft Office is required. Current PA nursing license required, RN or LPN. At least 1 year of experience with IDD/DD population preferred, but not required. Schedule is primarily daytime Monday-Friday, with occasional evenings or weekend hours to monitor medication administration or provide phone support. As a Full-Time Nurse Consultant, you will be eligible for the following benefits: Medical Insurance: $40 bi-weekly medical benefits for individuals, $50 bi-weekly medical benefits for family. Eligible after 60-day waiting period. Ancillary benefits (ex. dental, vision, etc.) provided through Lincoln Financial. Friendship Community provides a defined annual contribution that Full-Time Team Members can use towards ancillary benefits each year. The 2024 defined contribution is $150, which totals $5.77 per pay. Eligible after 60 day waiting period. Paid Time Off: Accrues per pay period, can be used immediately. Sick Time: Accrues per pay period, can be used immediately. Retirement: Team member is able to contribute to 403(b) retirement plan after 30 days. Holiday Pay (FT status): 7 paid holidays-New Year's Day, Easter Sunday (or Good Friday for Team Members who do not normally work weekends), Memorial Day, Fourth of July, Labor Day, Thanksgiving, Christmas. Benefits Offered to all Team Members: Wellness program Everence Federal Credit Union Everence Small Loan Wellspan Employee Assistance Program (EAP) Modern Eyes Membership Discount at our Heart Gallery Meals/Activities while on shift for DSPs Olivia Cunningham Education Fund Free my Strength app access In order to be considered for a position here at Friendship Community, please apply using the following link: ************************************ Friendship Community is an Equal Opportunity Employer and does not unlawfully discriminate on the basis of race, national or ethnic origin, color, religion, sex, sexual orientation, age, disability, citizenship or veteran's status. Please visit our careers page to see more job opportunities.

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);