- Stony Brook University (Stony Brook, NY)
- …our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following but are not limited to:** + Completes ... Utilization review screen for inpatient and observation cases. Activity...assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Albany, NY)
- …Work hours will be an 8.5-hour shift between 7:00am - 5:00pm CST. The Utilization Management Nurse 2 uses knowledge, communication, and independent critical ... Qualifications** + Associate's Degree or higher + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary...a team **Preferred Qualifications** + BSN + Knowledge of Utilization Management + Previous Medicare and Medicaid… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Trinity Health (Troy, NY)
- …differences often lead to innovative solutions. **Registered Nurse Professional Utilization Management Nurse - St. Peter's Hospital--Full-TIme TRACK ... to accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for inpatient and outpatient services in… more
- Cognizant (Albany, NY)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Trinity Health (Albany, NY)
- …in Albany, NY** is looking for an experienced RN to work as a Registered Professional Utilization Management Nurse (UMRN) per diem. The team is willing to ... **The selected candidate will** : + Be responsible for the utilization management , both concurrent and retroactive for inpatient and outpatient services in… more
- Trinity Health (Syracuse, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and other ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified… more
- Bassett Healthcare (Cooperstown, NY)
- …least 5 years of experience in Case Management , discharge planning, and/or Utilization Management Licensure/Certifications: + Registered Nurse or LMSW or ... the department. Oversees and works with the Director of Utilization Management to support and implement the...well as state and federal regulations.* Collaboration: Partner with nurse managers, nursing directors, and other leaders across the… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review for ... payment review.) + Prompt, courteous, professional and error free in performing utilization management functions. + Available to answer inbound phone calls… more
- CDPHP (Latham, NY)
- …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- Centene Corporation (New York, NY)
- …in this area is highly preferred.** **Position Purpose:** Leads and directs the utilization management team to ensure the appropriate application of policy ... and processes to help support best member outcomes. Participates in developing the utilization management strategies and objectives within utilization … more
- Centene Corporation (New York, NY)
- …**Must have an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:** Supervises Prior Authorization, Concurrent Review, ... Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Centene Corporation (New York, NY)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Elevance Health (Latham, NY)
- **Medical Management Nurse ** **Hours: Candidates will work 8a-5pm EST with 2 weekends per month** **Location** : This role enables associates to work virtually ... accommodation is granted as required by law. The **Medical Management Nurse ** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
