- Elevance Health (White Plains, NY)
- RN Utilization Management - Case Management (Medicaid Long Term Care) JR155671 **Location** : New York or New Jersey. **Virtual:** This role enables ... face-to-face onboarding and skill development as needed. The **Medical Management Nurse ** is responsible for review of...and Experiences:** + A combination of utilization review/ utilization management and Case … more
- Hackensack Meridian Health (Hackensack, NJ)
- …and regulatory/payer requirements. The role integrates and coordinates utilization management , care coordination, and discharge planning functions. RN ... with Nursing. **Education, Knowledge, Skills and Abilities Required:** + Case Manager, Registered Nurse Graduate...PC skills. + Current working knowledge of discharge planning, utilization management , case management… more
- BriteLife Recovery (Englewood, NJ)
- …assigned What we need from you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health ... compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals,… more
- MVP Health Care (Tarrytown, NY)
- …New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after hire. + At least 3 years of ... interaction **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes… more
- Mount Sinai Health System (New York, NY)
- …assure timely and efficient care to patients, the delivery of comprehensive front-line Case Management services, including utilization management , care ... degree preferred + 5 years of Case Management and 6 years as a clinical nurse...New York State + Certification in case management is preferred Non-Bargaining Unit, BEZ - Utilization… more
- Northwell Health (Huntington, NY)
- **Req Number** 161299 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
- CVS Health (Westwood, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... Qualifications** + Home Health and/or Hospice Experience + LTSS experience + Case management and/or discharge planning experience + Managed Care experience… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN / Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case ... or a minimum of 3-5 years? experience as a RN in an acute care setting. **Licensing and Certification...patients where utilization review, discharge planning, and/or case management will be needed using standardized… more
- Northwell Health (Mount Kisco, 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...entry date. + Current License to practice as a Registered Professional Nurse in New York State… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers' ... disability services for timely return to work. + Provides case management , utilization review, continued...MagnaCare policies and procedures. Essential Qualifications + Currently licensed Registered Nurse in the state of NY,… more
- Mount Sinai Health System (New York, NY)
- …admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve ... Manager (CM) will be responsible for all aspects of case management for an assigned group of...Sinai St. Luke's and Mount Sinai West, BEZ - Utilization Management - WST, Mount Sinai West… more
- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- Summary The RN CLC is responsible for all sections of...level degree in Nursing may have opportunity to become registered as a nurse with a state ... the nursing process when providing supervising direct resident care. The RN accepts responsibility for the coordination of care focused on resident education, self-… more
- Molina Healthcare (Yonkers, NY)
- …authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States...meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience**… more
- Nuvance Health (Carmel, NY)
- …Licensure as RN required; LMSW /LCSW preferred; Case management certification preferred. 2.Work Experience:3 years ... Leadership experience preferred; Utilization review, discharge planning or case management experience preferred. Location: Carmel-PHC 670 Stoneleigh Avenue… more
- Nuvance Health (Norwalk, CT)
- …the operations and activities of the Care Coordination Department including discharge planning, utilization management and high-risk case management . ... - FOR ELIGIBLE EXTERNAL CANDIDATES* Director, Acute Care Hospital Case Management Opportunity! *Required: BSN or MSW...not required. MSW considered* *Minimum Experience: five years* Desired: Registered Nurse with management experience.… more
- Nuvance Health (Norwalk, CT)
- *Description* *Clinical Care Coordinator/ RN Case Manager - Per Diem Opportunity!* *Rate: $51.50* *Summary:* The Clinical Care Coordinator - Unit is responsible ... in Nursing and minimum of three years job-related experience. Registered Nurse license State of CT with...and written. Minimum Experience: three years Desired: Certification in Case Management preferred or willing to obtain.… more
- Glengariff Rehabilitation and Healthcare Center (Glen Cove, NY)
- …and as directed by their supervisor and Administrator MDS Coordinator Qualifications: + Registered Nurse with current, active license in state of practice. + ... MDS Coordinator RN The Glengariff Healthcare Center is looking for...state regulations and company policy and procedures.Acts as in-house case manager by considering all aspects of the residents… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …certifications like Diabetes educator, Pediatric Nursing, Gerontological Nursing. * Current licensed Registered Nurse ( RN ) with state licensure; bachelor's ... About The Role Brighton Health Plan Solutions (BHPS) provides Case Management services to its clients. Cases...services to its clients. Cases are maintained by the Nurse Case manager. The Nurse … more
- FlexStaff (New York, NY)
- …contact hours of mandatory training requirements such as infection control coursework. - Case Management Certification recommended within two (2) years of the ... care. Serve the organization as a member of the management team, working alongside with all departments and employees...license and registration in New York State as a Registered Nurse required. Additional Requirements: - Be… more
- FlexStaff (New York, NY)
- …contact hours of mandatory training requirements such as infection control coursework. Case Management Certification recommended within two (2) years of the ... care. Serve the organization as a member of the management team, working alongside with all departments and employees...license and registration in New York State as a Registered Nurse required. Additional Requirements: Be legally… more