- Elevance Health (Yonkers, 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
- 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
- CVS Health (North Bergen, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... Qualifications** + Home Health and/or Home Hospice Experience + LTSS experience + Case management and/or discharge planning experience + Managed Care experience… more
- CVS Health (Fairfield, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... NJ Choice certification is a contingency of employment.** **Preferred Qualifications** + Case management and/or discharge planning experience preferred. + Home… 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
- 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
- Elevance Health (New York, NY)
- …The **LTSS Service Coordinator - RN Telehealth** is responsible for overall management of member's case within the scope of licensure; provides supervision ... and direction to non- RN clinicians participating in the member's case ...chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management , or similar role; or any… more
- Molina Healthcare (Yonkers, NY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- FlexStaff (White Plains, NY)
- …healthcare experience. + NYSED-approved infection control coursework (8+ contact hours). + Case Management Certification recommended within two years. + 2+ years ... **Req Number** 158644 Care Delivery Manager RN White Plains, NY Schedule: M-F, 8:30am to...care services (nursing homes, rehab, etc.). + Monitor care management effectiveness, utilization , and adjust plans as… more