- 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
- Centene Corporation (New York, NY)
- …Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact ... perspective on workplace flexibility. **Must have an active New York State RN license.** **Inpatient Utilization Management ** **Position Purpose:**… more
- 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
- CVS Health (Albany, NY)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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
- Trinity Health (Troy, NY)
- …often lead to innovative solutions. ** Registered Nurse Professional Utilization Management Nurse - St. Peter's Hospital--Full-TIme TRACK weekends** ... If you are looking for an RN position in Case Management and a...accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- Cognizant (Albany, NY)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Albany, NY)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… 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 (Latham, 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
- Guthrie (Binghamton, NY)
- …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b.… more
- Mount Sinai Health System (New York, NY)
- …Active RN license in the state of employment required + Certification in Case Management (CCM, ACM) or Utilization Management preferred. + 7+ years of ... experience in clinical acute clinical, utilization management , appeals management or related operations + 3+ years in a leadership or management role +… 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 ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory ... varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist,… more
- Northwell Health (Poughkeepsie, 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
- 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
- CVS Health (Albany, NY)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… more
- Northwell Health (Forest Hills, NY)
- …, preferred.Minimum five (5) years clinical experience as a registered nurse . Prior experience in utilization management and/or discharge planning, ... 2. are appropriately arranged for and financially approved.Performs concurrent utilization management .Reviews appropriateness of patient's admission, need for… more
- Trinity Health (Troy, NY)
- …experience in acute setting **Preferred requirements:** + 1+ year of experience in case management or utilization management + Case Management ... member of our caring, compassionate health care team the RN Case Manager will enjoy:** + Hours are 8am-4pm...Engage the patient and care team in the joint management of key patient outcomes such as management… more