Pennsylvania, United States · Remote OK
$68k–$106k/yr
Company :Highmark Inc.Job Description : JOB SUMMARY This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropri…
Skills: Utilization management, Case management, Clinical nursing, Regulatory compliance, Data analysis
Wilkes-Barre, Pennsylvania, United States · On-site
Location: Geisinger South Wilkes-Barre (GSWB) Shift: Nights (United States of America) Scheduled Weekly Hours: 36 Worker Type: Regular Exemption Status: No Job Summary: Geisinger is proud to offer an Inpatient Licensed P…
Skills: Communication, Computer literacy, Customer service, Multitasking, Teamwork
Wilkes-Barre, Pennsylvania, United States · On-site
PURPOSE AND SCOPE: The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision and coord…
Skills: Hemodialysis, Patient assessment, Nursing care, Medication administration, Emergency response
Wilkes-Barre, Pennsylvania, United States · On-site
Location: Geisinger Wyoming Valley (GWV) Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: No Job Summary: Geisinger is proud to offer an Inpatient RN a hiring incen…
Skills: Clinical skills, Communication, Interpersonal communication, Organizing, Preceptor skills
Scranton, Pennsylvania, United States · On-site
Location: Geisinger Community Medical Center (GCMC) Shift: Evenings (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: No Job Summary: Performs routine equipment room checks and …
Skills: Electrical maintenance, Plumbing, Preventive maintenance, Equipment repair, Building automation systems
Monroeville, Pennsylvania, United States · On-site
$30/hr–$35/hr
Licensed Practical Nurse (LPN) / Registered Nurse (RN) – Pediatric Home Health Monroeville, PA | Weekly Pay | Flexible Scheduling Pay Range: $30-$35/hour Referral Bonus Eligible – Uncapped Make a Difference One Patient a…
Skills: Pediatric nursing, Home health care, Medication administration, Patient assessment, Tracheostomy care
Waynesboro, Pennsylvania, United States · On-site
$28/hr–$33/hr
Angels of Care Pediatric Home Health is looking for Licensed Practical Nurses (LPN) in Waynesboro, PA and surrounding areas. Angels of Care has been caring for the medically fragile community across the nation since 2000…
Skills: Pediatric nursing, Patient assessment, Medication administration, Care coordination, Patient education
Township of Hanover, Pennsylvania, United States · On-site
Angels of Care Pediatric Home Health is looking for Registered Nurses (RN) and Licensed Practical Nurses (LPN) in Township of Hanover, PA and surrounding areas. Angels of Care has been caring for the medically fragile co…
Skills: Pediatric nursing, Patient assessment, Medication administration, Care coordination, Patient education
Dickson City, Pennsylvania, United States · On-site
We are hiring immediately for a full time HOUSEKEEPER position. Location: LVH Dickson City Hospital - 330 Main Street, Dickson City, PA 18519. Note: online applications accepted only. Schedule: Full time schedule. Monday…
Skills: Housekeeping, Cleaning, Customer Service, Sanitation, Floor Care
Johnstown, Pennsylvania, United States · On-site
Overview Vision Innovation Partners: Join Our Multi-Specialty Ophthalmology Team in Johnstown, PA! Vision Innovation Partners (VIP), a leading multi-specialty ophthalmology group, is excited to invite an enthusiastic and…
Skills: Ophthalmology, Cornea surgery, Patient care, Surgical procedures, Clinical excellence
Salem Township, Pennsylvania, United States · On-site
Overview At Vision Innovation Partners, we exist to protect and restore vision. Because Vision is our Mission, everyone at VIP focuses on providing great patient outcomes and experiences. A career at VIP provides opportu…
Skills: Optical product selection, Frame adjustments, Frame repairs, Customer service, Sales
Berwyn, Pennsylvania, United States · On-site
$46k–$52k/yr
Description Do you want to make a positive impact on the lives of the adults we serve? If so, you could become a part of a team creating meaningful and productive lives for those individuals that we serve. Being a Progra…
Skills: Supervision, Behavioral healthcare, Crisis prevention, Trauma informed care, CPR
Newfoundland, Pennsylvania, United States · On-site
$18/hr–$20/hr
Description Part-time, split shift similar to a school van schedule. The hours for this position will vary between 15-30 hours/week. Do you want to make a meaningful impact in the lives of adults with developmental and i…
Skills: Safe driving, Vehicle maintenance, Safety inspections, Supervision, Crisis prevention
Philadelphia, Pennsylvania, United States · On-site
$69k–$104k/yr
Job Summary This position will provide clinical research support services to researchers within the assigned departments. This individual will support such researchers providing the required elements necessary to retain …
Skills: Clinical research, Nursing assessment, Regulatory compliance, IRB documentation, Phlebotomy
Middletown Township, Pennsylvania, United States · On-site
$35/hr–$43/hr
Overview Join our team and grow with us both professionally and personally! Next day pay: Work today, get paid tomorrow with our PayActiv benefit! We strongly believe in providing our team members with great benefits, su…
Skills: Registered Nurse, Medical treatment, Personal care, Skilled nursing, CPR
Philadelphia, Pennsylvania, United States · On-site
$275k–$900k/yr
Philadelphia, PA – Seeking Emergency Medicine Physicians Join the Physician Partnership Where You Can Increase Your Impact Vituity’s ownership model provides autonomy, local control, and a national system of support, so …
Skills: Emergency Medicine, Patient Care, Clinical Leadership, Stroke Care, Pediatric Emergency Care
Middletown Township, Pennsylvania, United States · On-site
$275k–$900k/yr
Langhorne, PA – Seeking Emergency Medicine Physicians Join the Physician Partnership Where You Can Increase Your Impact Vituity’s ownership model provides autonomy, local control, and a national system of support, so you…
Skills: Emergency medicine, Trauma care, Patient care, Clinical leadership, STEMI management
Philadelphia, Pennsylvania, United States · On-site
Performs and/or assists with a variety of radiologic and CT procedures in accordance with established protocols from radiologists or referring physicians. Operates radiographic and CT equipment safely and responsibly, ad…
Skills: Radiologic procedures, CT procedures, Radiation safety, Diagnostic imaging, Cross-sectional anatomy
Philadelphia, Pennsylvania, United States · On-site
The Monitor Technician performs high-level on-going patient surveillance and provides nursing/clinicians with immediate notification of any changes in cardiac rate/rhythm. Responsible for monitoring, recording, and repor…
Skills: Patient surveillance, Cardiac monitoring, Rhythm interpretation, Telemetry, Equipment troubleshooting
Philadelphia, Pennsylvania, United States · On-site
This position supports the Fox Chase Cancer Center Office of Clinical Research at Temple University Hospital, Main Campus or East Norriton and Buckingham Campuses. Coordinates and facilitates the conduct of clinical rese…
Skills: Clinical research coordination, Protocol compliance, Data management, Specimen collection, Phlebotomy
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The Care Manager RN implements utilization management strategies to ensure appropriate resource use and identifies opportunities for health coaching or case management. They also monitor healthcare delivery, educate providers and members, and analyze data to improve care outcomes and satisfaction.
Candidates must have a current RN license in Pennsylvania or a multi-state compact license and at least 3 years of progressive clinical experience. A Bachelor’s degree in Nursing is preferred, along with experience in utilization management or managed care.
This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.
Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline.
Function in accordance with applicable state, federal laws and regulatory compliance.
Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
Promote quality and efficiency in the delivery of care management services.
Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws.
Practice within the scope of ethical principles.
Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member.
Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
Develop and sustain positive working relationships with internal and external customers.
Utilize outcomes data to improve ongoing care management services.
Other duties as assigned or requested
None
None
Bachelor’s Degree in Nursing
3 years of related, progressive clinical experience in the area of specialization
Experience in a clinical setting
Experience in UM/CM/QA/Managed Care
Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional specific state licensure(s) may be required depending on where clinical care is being provided.
Certification in utilization management or a related field
Working knowledge of pertinent regulatory and compliance guidelines and medical policies
Ability to multi task and perform in a fast paced and often intense environment
Excellent written and verbal communication skills
Ability to analyze data, measure outcomes, and develop action plans
Be enthusiastic, innovative, and flexible
Be a team player who possesses strong analytical and organizational skills
Demonstrated ability to prioritize work demands and meet deadlines
Excellent computer and software knowledge and skills
None
Travel Requirement
0% - 25%
Office-Based
Teaches/trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Does Not Apply
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely, Occasionally
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Our mission is to create a remarkable health experience, freeing people to be their best.
Allegheny Health Network is an integrated health care delivery system serving the greater Western Pennsylvania region. More than 2,600 physicians and 21,000 employees serve the system's 16 hospitals as well as its ambulatory medical and surgery centers, Health + Wellness Pavilions, and hundreds of physician practice locations. AHN is a proud part of Highmark Health.
Offices: 4800 Friendship Ave, Pittsburgh, Pennsylvania 15224, US · 2570 Haymaker Rd, Monroeville, Pennsylvania 15146, US · 320 E North Ave, Pittsburgh, Pennsylvania 15212, US · 12351 Perry Hwy, Wexford, Pennsylvania 15090, US · 1301 Carlisle St, Natrona Heights, Pennsylvania 15065, US
Based on 2703 listings with disclosed salaries, most healthcare jobs in Pennsylvania pay between $63k–$180k per year. Individual offers vary with seniority, company size, and specialization.
There are currently 27,833 open healthcare positions in Pennsylvania listed on Clera. New openings are added daily as companies post roles.
Companies currently hiring include UPMC, CVS Health, Temple Health – Temple University Health System, Allegheny Health Network, EmmUcare Home Health, among others. Browse the listings above to see every active employer.
Yes — 2713 of the 27833 open healthcare positions offer remote or hybrid work (880 remote, 1833 hybrid).
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.
