- Excellus BlueCross BlueShield (Utica, 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
- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... occasional weekends (typically requires 6 weekends a year). Utilization Management Registered Nurse ( RN ) Position Responsibilities: + Works… 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)
- …Qualifications** + Must reside in EST zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required + Must have active ... current and unrestricted RN licensure in state of residence + 1+ year(s)...able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent ... outcomes are achieved, and high-quality professional practice is realized. **Position Purpose:** Registered Nurse Coordinator is a dynamic leadership role that… 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
- 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
- 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
- Molina Healthcare (Albany, NY)
- …knowledge on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse ( RN ) Program and an Associate's or Bachelor's ... RN , LVN, or bachelor's trained candidates with a strong background in Utilization Management . Additionally, the applicant should have proven experience as a… 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
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... accredited Nursing School or College; current New York State, RN License required, BSN Bachelor of Science in Nursing...current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound… 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
- 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
- Arnot Health (Elmira, NY)
- …of an approved registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three ... patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's average caseload will… more
- Catholic Health Services (Smithtown, NY)
- …Nursing (BSN) degree required Master of Science degree strongly preferred Licensure: New York Registered Nurse ( RN ) License & Registration Salary Range USD ... supervisors will report to them. The Director of Care Management and Nurse Operations will: Work collaboratively... management leadership role is required Experience in utilization management , working with managed care organizations,… more
- Trinity Health (Syracuse, NY)
- …affiliated nursing program. BSN graduate preferred. + **Licensure** : Current Licensure as a Registered Nurse RN in New York. + **Certification** : BLS/CPR. ... **Shift:** 12 Hour Day Shift **Description:** At **St. Joseph's Health** the ** Registered Nurse Inpatient Clinical Care Manager** assumes the responsibility and… more
- Northwell Health (Huntington, NY)
- **Req Number** 152919 Registered Nurse Case Manager - FlexStaff Serves as liaison between the patient and facility/physician. Ensures a continuum of quality ... + Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria +… more
- Catholic Health (Buffalo, NY)
- …Weekend and Holiday Rotation Hours: 8:00 am to 4:00 pm Summary: The Registered Nurse ( RN ) Care Manager- Utilization Review, as an active member of the ... Care Management and interdisciplinary care team, provides comprehensive ...BS Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York… more