Utilization Review Manager - Home Care jobs in Pennsylvania

Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)

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Utilization Review Case Manager
  • Main Line Health Careers
  • Malvern, PA FULL_TIME

  • Could you be our next Utilization Review Case Manager at Bryn Mawr Rehab?

    Why work as a Utilization Review Case Manager with Main Line Health?

    Make an Impact! 

    • This position requires an RN who is responsible for reviewing medical records for the appropriate level of care, medical necessity, length of stay, and authorization denials for hospitalized patients. An understanding of the severity of an array of illnesses, intensity of service, and care coordination needs is key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient.

    • Develop and Grow your Career! Invest in furthering your education through seeking certifications or advanced degrees by taking advantage of our Tuition Reimbursement! This position is eligible for up to $6,000 per year based upon your Full or Part Time status.

    • Join the Team! Like our patients, the Main Line Health Family encompasses a wide range of backgrounds and abilities. Just as each of our patients requires a personalized care plan, each of our employees, physicians, and volunteers, bring distinctive talents to Main Line Health. Regardless of our unique design, we all share a purpose: providing superior service and care.

    • Position-Specific Benefits include: You are eligible for up to 240 hours of paid time off per year based on your Full or Part Time status. We also offer a number of employee discounts to various activities, services, and vendors... And employee parking is always free!

    Position: UM Review Case Manager
    Shift: day shift

    Experience:
    1. Minimum of 3 years direct medical-surgical experience 
    2. 2 years in medical Case Management, Utilization Review, Discharge Planning or other appropriate health-related field. Has working knowledge of insurance coding, and reimbursement including but not limited to Medicare, Medicaid, and Managed Care.

    Education:
    Graduate of an accredited School of Nursing. Bachelor’s degree preferred

    Licensures/Certifications:
    1. Current licensure in the Commonwealth of PA as a Registered Nurse 
    2. Case Management certification preferred or active pursuance.



    All positions are eligible for an employee referral bonus. The amount varies and is outlined on Wellspring. To be paid for the referral, employees must share the job link with their referral and the candidate must use the link to complete an application. The employee referral program details can be found on Wellspring.

    Additional Information
  • 13 Days Ago

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Manager Analytics - Customer Utilization
  • Customer Utilization - Independence Blue Cross Careers
  • Philadelphia, PA FULL_TIME
  • Bring your drive for excellence, team orientation and customer commitment to Independence Blue Cross; help us renew and reimagine our business and shape the future of health care. Our organization is ...
  • 28 Days Ago

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DA CM Utilization Review-Continuing Care Coordinator
  • SOUTHWEST BEHAVIORAL CARE INC
  • Greensburg, PA FULL_TIME
  • SOUTHWEST BEHAVIORAL CARE, INC. POSITION : D&A Case Management Utilization Review/Continuing Care Coordinator Full-Time Position -Greensburg, PA Location Work alongside our HEROES… APPLY TODAY AND BEC...
  • 7 Days Ago

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DA CM Utilization Review-Continuing Care Coordinator
  • SPHS GROUP
  • Greensburg, PA OTHER
  • Job Details Job Location: Southwest Behavioral Care D&A Case Management - Greensburg, PA Position Type: Full Time Salary Range: Undisclosed Description SOUTHWEST BEHAVIORAL CARE, INC. POSITION : D&A C...
  • 6 Days Ago

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Utilization Review Specialist
  • Gaudenzia
  • Harrisburg, PA FULL_TIME
  • Overview We need hope-bringers and changemakers — because the work we all do matters. If you’re passionate about making an impact with your time and being someone’s light in the darkness, we want you ...
  • 22 Days Ago

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Utilization Review Specialist
  • Gaudenzia
  • Lancaster, PA FULL_TIME
  • Overview Salary is commensurate with experience Picture Yourself At Gaudenzia as a Utilization Review Specialist at our Pregnant & Parenting Women's Programs! We need hope-bringers and changemakers — ...
  • 24 Days Ago

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Director Utilization Management
  • AMI Network
  • San Diego, CA
  • I’m partnered with a major health plan in San Diego to find a Director of Utilization Management! This top-rated Medicai...
  • 3/28/2024 12:00:00 AM

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Utilities Manager
  • City of Upland, CA
  • Upland, CA
  • Salary : $124,287.53 - $158,625.88 Annually Location : Public Works - 1370 N. Benson Ave Upland, CA Job Type: Full Time ...
  • 3/28/2024 12:00:00 AM

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Utilities Manager (At-Will)
  • City of Rialto, CA
  • Rialto, CA
  • Salary : $116,448.00 - $156,060.00 Annually Location : Rialto, CA Job Type: Full-Time Job Number: 23-072 Department: RUA...
  • 3/28/2024 12:00:00 AM

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Maintenance and Utilities Manager
  • The Judge Group
  • Somerset, NJ
  • Do you love candy and snacks? Are you looking to join an ever evolving and rapidly growing team? PIM Brands might just b...
  • 3/28/2024 12:00:00 AM

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Utilization Management Assistant
  • Trinity Health
  • Des Moines, IA
  • Employment Type: Full timeShift: Description: GENERAL SUMMARY: Under general supervision, the Utilization Management Ass...
  • 3/28/2024 12:00:00 AM

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Utility Manager
  • Prairie Band Potawatomi Nation
  • Mayetta, KS
  • Tier: 2 Department: Administration Supervisor: General Manager of Operations Location: 16281 Q Road, Mayetta KS 66509 Pa...
  • 3/25/2024 12:00:00 AM

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Utility Management Consultant
  • HDR, Inc.
  • Charlotte, NC
  • Qualifications and Experience * BS in Civil or Environmental Engineering or a related technical discipline required. * M...
  • 3/25/2024 12:00:00 AM

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Utilization Management Coordinator
  • Hackensack Meridian Health
  • Point Pleasant Beach, NJ
  • Description: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients ...
  • 3/25/2024 12:00:00 AM

Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east. Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$75,886 to $96,750