- CVS Health (Albany, NY)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN ) supports daily coordination of care across healthcare continuum with the ... preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN...care related field required. Current registration as a Licensed Registered Professional Nurse in New York State.… more
- Humana (Albany, NY)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG...with Triad Team and health care team. Minimum Qualifications:* Registered nurse with a New York State… more
- CDPHP (Albany, NY)
- …Minimum two (2) years of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...recognized criteria and CDPHP policies, and procedures. QUALIFICATIONS: + Registered Nurse with a current New York… more
- Trinity Health (Albany, NY)
- …experience in acute setting **Preferred requirements:** + 1+ year of experience in case management or utilization management + Case Management ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN Case Manager** **Full-Time Days** **St. Peter's Hospital**...Engage the patient and care team in the joint management of key patient outcomes such as management… more
- Trinity Health (Troy, NY)
- …through Friday - Samaritan HospitalIf you are looking for a position in RN ( Registered Nurse ) Case Management in a dynamic hospital, this could be your ... member of our caring, compassionate health care team the RN Case Manager will enjoy: Tuition assistance Great shift...in acute settingPreferred requirements:1+ year of experience in case management or utilization managementCase Management … more
- Albany Medical Center (Albany, NY)
- …knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact State ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to… more
- Highmark Health (Albany, NY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Sharecare (Albany, NY)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… more
- Molina Healthcare (Albany, NY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Molina Healthcare (Albany, NY)
- …reliable transportation. **Preferred Experience** Previous experience in ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …candidates will be considered as vacancies become available. Responsibilities The Staff Registered Nurse ( RN ) is responsible for providing competent, ... and decision-making, deliberate planning, and critical thinking skills. The duties of the Registered Nurse include but are not limited to: Independently plans… more
- Ellis Medicine (Schenectady, NY)
- …Services discharge planning guidelines and departmental/organizational policies and processes + Utilization Management : + Ensures order in chart/EMR coincides ... RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This...the Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration… more
- Fresenius Medical Center (Albany, NY)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... quality of patient care, as defined by the quality goals, by working with management to ensure that policies and procedures are followed. + Assists with implementing… more
- Evolent (Albany, NY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Molina Healthcare (Albany, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...transplants; the ideal candidate will have experience either in utilization review or case management for transplants.… more
- Molina Healthcare (Albany, NY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... the state health plan's Healthcare Services (clinical operations) teams including Utilization Management (prior-authorization, inpatient review) and Care … more
- Elevance Health (Latham, NY)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by...**Preferred Skills, Capabilities and Experiences** : + Experience in Utilization Management preferred. + Board Certified Behavioral… more
- Albany Medical Center (Albany, NY)
- …the field of Clinical Social Work or Nursing with experience in Case Management , Utilization Review and Discharge Planning. * BLS Certification. * Demonstrated ... principles of conflict resolution and promote consensus building.* Represents Case Management /Social Work at organizational committee meetings as directed* Serves as… more