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The Ohio State University Wexner Medical Center
Full time
 
PCRM Senior Specialist Utilization Management
The Ohio State University Wexner Medical Center Columbus, OH, USA
Current Employees and Students: Please log in to Workday to use the internal job search and application process. Scope of Position This position serves as a Patient Care Resource Manager (PCRM) – Senior Specialist for health plan utilization management programs and reports to the Utilization Manager. The PCRM – Senior Specialist is responsible for delivering superior customer service and achieving clinical and operational excellence as it relates to the implementation and execution of OSU Health Plan medical/pharmacy benefits and utilization management. The position is tasked with ensuring highly personalized and cost-effective care for all OSU Health Plan members. The PCRM – Senior Specialist is responsible for resolving escalated member/provider concerns and working with the Utilization Manager and team clinicians to provide quality assurance for our top-quality clinical programs. The PCRM – Senior Specialist provides informal guidance to other care management program staff...

Dec 11, 2025
WS
Interventional Pain Management
WellSpan Health Lewisburg, PA, USA
General Summary Responsible for monitoring patient comfort before, during, and after surgical or medical procedures through the administration of anesthesia and other medications. Administers anesthetics during surgery and adjusts them as needed. Monitor patients' vital signs. Join Our Growing Interventional Pain Practice Location: Lewisburg, PA Position: Interventional Pain Medicine Physician Employment Type: Full-Time Why Join Us? We are a mission-driven, physician-led integrated health system dedicated to improving health through exceptional care for all. Our Interventional Pain practice is well-established and expanding -with a major renovation underway to include a second procedure room, additional prep and recovery bays , and enhanced patient flow. This is an exciting opportunity to be part of a highly invested system that prioritizes innovation and patient-centered care. Practice Highlights Collaborative Team: Join 2...

Nov 24, 2025
Highmark Health
Full time
 
Care Manager RN - Utilization Management (UM) Remote
Highmark Health West Chester, PA, USA
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 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. ESSENTIAL RESPONSIBILITIES 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...

Dec 21, 2025
UV
Full time
 
Registered Nurse- Case Management- Float
US Veterans Health Administration Iowa City, IA, USA
Summary The Registered Nurse- Case Management- Float falls under the clinical pathway, as a direct care nurse, and reports to the Clinical Manager, Patient Care Services Service Line This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Internal to an agency Current federal employees of the hiring agency that posted the job announcement. Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this occupational series. For more information, refer to Required Documents below Duties Major duties include, but not limited to: Possess the ability to cross-cover all the necessary clinic areas and other responsibilities as assigned. Provides cover for anticipated and unanticipated absences of Case Managers Acts as a consultant in specialty clinical practice Identifies patient care needs in accordance with the established standards, policies, and...

Nov 23, 2025
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