- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- 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
- CVS Health (Albany, NY)
- …in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state ... Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral… 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
- Mount Sinai Health System (New York, NY)
- …and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care facilitation and ... field, Master's degree preferred + 5 years of Case Management and 6 years as a clinical nurse... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West… more
- CVS Health (Albany, NY)
- …is fully meeting all metrics._** **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN ... applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization or Utilization Management experience + Managed care experience +… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …coordinates and is accountable for the daily work of employees who provide utilization management , clinical and medical necessity claim related services and ... PT, NP, PA, or Dietician) with a minimum of three years of utilization management /quality improvement experience or equivalent required. + Must possess a… more
- Guthrie (Binghamton, NY)
- …necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this ... Provides health care services regarding admissions, case management , discharge planning and utilization review. Responsibilites: Reviews admissions and service… 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
- Crouse Hospital (Syracuse, NY)
- …management of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing ... Manager who is responsible for providing day to day management of the RN Care Managers in...agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State +… more
- Northwell Health (Staten Island, NY)
- …Nursing, required. + Current license to practice as a Registered Professional Nurse in New York State. + Case Management Certification, preferred. + Minimum ... another level of care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for… more
- Northwell Health (Valley Stream, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives....entry date. + Current License to practice as a Registered Professional Nurse in New York State… more
- CVS Health (Albany, NY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Albany, NY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator… more
- Saratoga Hospital (Saratoga Springs, NY)
- …criteria to identify severity of illness & intensity of service for appropriate utilization management and 1st level criteria reviews. Documents required data in ... the Collaborative Practice Groups, Magnet Councils, Interdisciplinary Committees and/or Utilization Management Committee. Develops and implements interdisciplinary… more
- Saratoga Hospital (Saratoga Springs, NY)
- …criteria to identify severity of illness & intensity of service for appropriate utilization management and 1st level criteria reviews. Documents required data in ... the Collaborative Practice Groups, Magnet Councils, Interdisciplinary Committees and/or Utilization Management Committee. Develops and implements interdisciplinary… more
- Crouse Hospital (Syracuse, NY)
- …establish the plan of care. Care Manager Position Requirements: + Must have a current Registered Nurse ( RN ) license. + Graduate from an accredited nursing ... maintaining the quality of care. + Participates in the utilization management process using standards of care...YMCA Subsidy program. + Clinical Nursing Pathway Program for Registered Nurses designed to foster career growth and progression.… more
- Stony Brook University (Stony Brook, NY)
- …including managing Case Management leadership and staff functions related to case management and utilization management activities. + Manage and mentor a ... design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead...degree. * Possession of license to practice as a registered nurse in New York State *… more