ZipRecruiter

Log In

2

Remote Rn Case Review Jobs in Pennsylvania (NOW HIRING)

Harris

$10/hr

EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min ... Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ...

Harris

$10/hr

EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min ... Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ...

Harris

$10/hr

EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min ... Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ...

Ourhrconnect

Associate's degree in Nursing with an active RN license. * Required Work Experience : 5 years ... Sound clinical review judgement. Independent thinking and strong organizational skills. * Required ...

Ourhrconnect

Associate's degree in Nursing with an active RN license. * Required Work Experience : 5 years ... Sound clinical review judgement. Independent thinking and strong organizational skills. * Required ...

Ourhrconnect

Associate's degree in Nursing with an active RN license. * Required Work Experience : 5 years ... Sound clinical review judgement. Independent thinking and strong organizational skills. * Required ...

Ourhrconnect

Coordinator, Medical Affairs

Indiana, PA · On-site +1

Associate's degree in Nursing with an active RN license. * Required Work Experience : 5 years ... Sound clinical review judgement. Independent thinking and strong organizational skills. * Required ...

previous page

Showing results 41-60

All JobsRn Case Review JobsRemote Rn Case Review JobsRemote Rn Case Review Jobs in Pennsylvania

Remote Rn Case Review information

What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?

AspectRemote Rn Case ReviewRemote Rn Utilization Review
CredentialsRegistered Nurse (RN), licensure, case review certificationsRegistered Nurse (RN), licensure, utilization review certifications
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, healthcare settings, insurance companies
Employer & IndustryHospitals, insurance firms, healthcare providersInsurance companies, healthcare management organizations

Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

What are the most commonly searched types of Rn Case Review jobs in Pennsylvania? The most popular types of Rn Case Review jobs in Pennsylvania are:
What are popular job titles related to Remote Rn Case Review jobs in Pennsylvania? For Remote Rn Case Review jobs in Pennsylvania, the most frequently searched job titles are:
What job categories do people searching Remote Rn Case Review jobs in Pennsylvania look for? The top searched job categories for Remote Rn Case Review jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Remote Rn Case Review jobs? Cities in Pennsylvania with the most Remote Rn Case Review job openings:
Remote Rn Case Review jobs near you

Clinical Care Manager (RN) - Allegheny County

UPMC - Pittsburgh Medical Center

Pittsburgh, PA • Remote

$63K - $86K/yr

Full-time

Posted 18 days ago

Job description

Purpose:
The UPMC Health Plan is seeking a full-time Clinical Care Manager to support the Community Team throughout Allegheny County.

The Clinical Care Manager will work flexible hours, Monday through Friday, with travel throughout Allegheny County to meet with members within the community. This role is primarily community-based with the majority of time spent traveling in the community, with the remainder of the Care Manager's work completed remotely/from home! 

The Clinical Care Manager is responsible for care coordination and health education with identified Health Plan members through face-to-face collaboration with members and their caregivers and providers. Identifies members' medical, behavioral, and social needs and barriers to care. Develops a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. Collaborates and facilitates care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by face-to-face interactions in their community including the hospital, providers' offices, home, and other health care facilities. 


Responsibilities:
 

  • Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care.
  • Document all activities in the Health Plan's care management tracking system following Health
  • Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. 
  • Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate.
  • Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate.
  • Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. 
  • Engage members in the Beating the Blues or other education or self-management programs. 
  • Provide members with appropriate education materials or resources to enhance their knowledge and skills related to health or lifestyle management.
  • Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. 
  • Assist member to schedule a follow up appointment after emergency room visits or hospitalizations.
  • Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
  • Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. 
  • Update the plan of care following review and communicate recommendations to the member and providers.
  • Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. 
  • Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care.
  • Minimum of 2 years of experience in a clinical setting and case management nursing required. BSN preferred. 
  • Minimum 1 year of health insurance experience required. 
  • 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred
  • Excellent organizational skillsHigh level of oral and written communication skills
  • Computer proficiency required
    Licensure, Certifications, and Clearances:
     
  • Case management certification or approved clinical certification required (or must be obtained within 2 years of hire to remain in role) CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
  • Automotive Insurance
  • Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
  • Certified Case Manager (CCM)
  • Driver's License
  • Registered Nurse (RN)
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

*Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.
UPMC is an Equal Opportunity Employer/Disability/Veteran

Apply