- Rochester Regional Health (Rochester, NY)
- Job Title: Utilization Review Specialist ( RN ) Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 Hours ... (Full-Time) Schedule: Monday - Friday, Days SUMMARY:The Utilization Review Specialist actively participates...Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse -… more
- Cognizant (Albany, NY)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- City of New York (New York, NY)
- …required; make professional recommendations accordingly. - Keep abreast of medical and utilization review techniques and developments relative to the nursing ... Nurse in the Bureau of Medical and Professional Review (BMPR) of Home Care Services Program. As the...- 50935 Qualifications 1. A valid New York State Registered Nurse License and completion of one… more
- DePaul (Rochester, NY)
- …overall Quality Management planning. + Performs all other duties as assigned. Qualifications + Registered Nurse or Licensed Practical Nurse with 3 years of ... Overview The Quality Management Specialist works with the Quality Management Department to...reporting and follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual… more
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details The Professional Fee (ProFee) Clinical Documentation Specialist (CDS) will serve as an advisor and expert resource for providers ... The ProFee CDS will focus on pre-visit provider support, post-visit provider review , and collaboration and education with providers. Pre-visit provider support -… more
- Catholic Health (Buffalo, NY)
- …(the payers) and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health Information ... management, operational analysis, information systems or related field + Registered Nurse with a four (4) year...approved by management + Certification in a Nationally Recognized Utilization Review Criteria set is preferred EXPERIENCE… more
- WMCHealth (West Nyack, NY)
- …national care management standards and community resources highly preferred. Education: Registered Nurse , Bachelor's degree preferred Licenses / Certifications : ... performed by the Care Manager through extensive medical record review , face to face and/or telephonic encounters with assigned...Current license as a Registered Nurse is required. About Us: Bon… more
- STG International (Kingston, NY)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. + ... Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes,...Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse … more
- Independent Health (Buffalo, NY)
- …with regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... **Overview** The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as… more
- STG International (Auburn, NY)
- …in the management/coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. * ... Participates in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes,...Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse … more