- 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)
- …work Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of ... in the state of residence (LMSW, LCSW, LISW, LPC, or comparable) or Registered Nurse licensure with psychiatric specialty, certification, or experience in state… 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 ... management is preferred Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West...by focusing on patient processes. 9. Develops and implements Utilization Review (UR) based on internal data… more
- Guthrie (Binghamton, NY)
- …services regarding admissions, case management , discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… 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)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of… 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 ... agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State +...acute care discharge planning + Preferred - Acute care utilization review experience Benefits Overview: + Medical,… more
- Northwell Health (Staten Island, NY)
- …care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness ... license to practice as a Registered Professional Nurse in New York State. + Case Management... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more
- Evolent (Albany, NY)
- …As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… 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...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… 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...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- Saratoga Hospital (Saratoga Springs, NY)
- …coordination, comprehensive discharge planning, daily rounding with interdisciplinary team, utilization review / management , readmission avoidance action plan ... Documents required data in Allscripts and follows the Care Management Plan Policy for utilization review...and regulatory requirements. Certifications / Licensure + Current NYS RN nursing license + PRI Certification preferred + CCM… more
- Saratoga Hospital (Saratoga Springs, NY)
- …coordination, comprehensive discharge planning, daily rounding with interdisciplinary team, utilization review / management , readmission avoidance action plan ... and 1st level criteria reviews. Documents required data in Allscripts and follows the Care Management Plan Policy for utilization review & management .… more
- Stony Brook University (Stony Brook, NY)
- …Coordinate the design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead initiatives ... Management leadership and staff functions related to case management and utilization management activities....degree. * Possession of license to practice 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 ... Coordination Services team is hiring a Care Manager to review the services delivered to patients and compare it...maintaining the quality of care. + Participates in the utilization management process using standards of care… more
- Arnot Health (Elmira, NY)
- …related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. ... nursing program with a current license as a registered nurse . BSN or Case Management...nursing in acute care hospital setting or two years utilization management in an acute care hospital… more
- Independent Health (Buffalo, NY)
- …licensed behavioral health professional (such as a LCSW, LMSW, LMHC, LPC, LMFT) or a Registered Nurse ( RN ) with active, unrestricted NYS license required. + ... that fosters growth, innovation and collaboration. **Overview** The Behavioral Health Utilization Review Clinician will primarily be responsible for managing… more