- Centene Corporation (New York, NY)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Independent Health (Buffalo, NY)
- …benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review to ... nurse (RN) required. + Two (2) years of clinical experience as an RN in a varied ...documentation of clinical information for medical necessity review of all requests, procedures, admissions, and concurrent… more
- Cognizant (Albany, NY)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- CDPHP (Latham, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care… more
- UHS (Johnson City, NY)
- …registry by working closely with the TPM and Trauma Registrars to assure accurate, concurrent clinical data abstraction and entry into the trauma registry. The ... Position OverviewThe Trauma Resource Nurse (TRN) has responsibility for concurrent ...to assure the provision of safe, efficient and effective clinical care to all injured patient by continuously monitoring,… more
- Albany Medical Center (Albany, NY)
- …environment. + Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or ... management to coordinate the appropriate use of resources to achieve maximum clinical and financial outcomes. The Case Manager participates in maintaining quality… more
- Northwell Health (Lake Success, NY)
- … clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification ... of clinical documentation from the physician(s) on a ...date. *Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Northwell Health (Sleepy Hollow, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. ... collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of...and continued length of stay; Facilitates throughput. + Conducts clinical reviews and interacts with third party payers to… more
- Northwell Health (Poughkeepsie, NY)
- …+ Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria ... collaboration with the health care team + Conducts chart review for appropriateness of admission and continued length of...and continued length of stay; Facilitates throughput + Conducts clinical reviews and interacts with third party payers to… more
- Kaleida Health (Buffalo, NY)
- …coding team, Nursing, Patient Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding ... care team. The CDS is also responsible for audit review to identify potential documentation deficiencies in specific records...acute care, medical/surgical or ICU/ED as a licensed Registered Nurse required. 1 year of experience in Clinical… more
- Kaleida Health (Buffalo, NY)
- …coding team, Nursing, Patient Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding ... require leadership abilities.** **Education And Credentials** Bachelors degree required. Registered Nurse required. Cert. Clinical Doc Specialist (CCS) required… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Clinical Program Manager for Geriatrics and Palliative Medicine supports the Vice Chair of Quality and Clinical Information and oversees ... as a component within the department or larger health system. The Clinical Program Manager leads quality and performance improvement programs in collaboration with… more
- Mount Sinai Health System (New York, NY)
- …preferred. + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign ... 4. Conducts Root Cause Analysis investigations which include assessing need for focused review by departments, and/or clinical chairpersons for peer reviews. 5.… more
- Centene Corporation (New York, NY)
- …be working with our Children member's - ages 0-18.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… more
- Trinity Health (Syracuse, NY)
- …administrative requirements for Utilization Management and works collaboratively with Utilization Management/ Concurrent Review Nurse , physicians, staff and ... possible concurrent denials, forwards information to the appropriate Utilization Management/ Concurrent Review Nurse within identified process standards *… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. 13. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Northwell Health (Forest Hills, NY)
- …In concert with attending physician.Responds to third party payer requests for concurrent clinical information providing all relevant documentation to ensure ... Masters Degree, preferred.Current license to practice as a Registered Professional Nurse in New York State.Patient Review Instruments (PRI) Certification,… more
- Centene Corporation (New York, NY)
- …Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review … more
- Guthrie (Binghamton, NY)
- …two (2) years of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who holds a bachelor's degree in a ... Case Manager utilizes industry accepted processes for achieving optimal patient, clinical , and operational outcomes timely, coordinated, and in cost effective… more