- Albany Medical Center (Albany, NY)
- Department/Unit: Care Management/Social Work Work Shift: Day (United States of America) Utilization Review Nurse Salary Range: $31.28 - $51.61 per hour ... for assigned patients. Qualifications and Ideal Characteristics + Registered nurse with a New York State current license. +...Basic knowledge of computer systems with skills applicable to utilization review process. + Excellent written and… more
- Glens Falls Hospital (Glens Falls, NY)
- …be foundhere. **Job:** **Nursing - Case Management* **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On Bonus for ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing… 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 ... for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and...acute care experience is required as a Licensed Practical Nurse . + Minimum of two (2) years Utilization… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Salary… more
- Trinity Health (Albany, NY)
- …equivalent combination of healthcare and supervisory experience. + Strong knowledge of utilization review practices + PC literate, including Microsoft Office ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Title:** Nurse Senior_ Utilization Management Lead **Shift** : M-F 8hr days/Hybrid (2 days… more
- New York State Civil Service (Marcy, NY)
- …years of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning. Duties Description To be discussed at ... HELP No Agency Corrections and Community Supervision, Department of Title Registered Nurse 2 - Utilization Occupational Category Health Care, Human/Social… more
- Elevance Health (Latham, NY)
- …as part of consideration for employment. **Medical Oncology Medical Director - Utilization Review ** + Job Family: MED > Licensed Physician/Doctor/Dentist + ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Catholic Health (Lockport, NY)
- …Rotation Hours: 8:00a-4:00p, 9:00a-5:00p, 10:00a-6:00p, 11:00a-7:00p Summary: The RN Care Manager, Utilization Review / Transitions of Care, as an active member ... the Care Management and interdisciplinary care team, provides comprehensive Utilization Review and transitions of care services...Education, or BS in Health related field + Registered Nurse , licensed ( unrestricted ) in New York State… more
- Crouse Hospital (Syracuse, NY)
- Utilization Management RN has well-developed knowledge and is proficient with standard Utilization Review processes. The Utilization Management RN is an ... on their appropriate admission status. This individual will support the Utilization Management process by maintaining effective and efficient processes for… more
- Humana (Albany, NY)
- …help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge ... three (3) years of clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from… more
- WMCHealth (Valhalla, NY)
- …implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical ... York State Department of Education, as a registered professional nurse . Training and Experience: three years of experience where...of which must have been in the area of utilization review , quality assurance, risk management or… more
- Elevance Health (Latham, NY)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... a check, or ask you for payment as part of consideration for employment. ** Utilization Management Representative II** + Job Family: CUS > Care Support + Type: Full… more
- Elevance Health (Latham, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... a check, or ask you for payment as part of consideration for employment. ** Utilization Management Representative I** + Job Family: CUS > Care Support + Type: Full… more
- Humana (Albany, NY)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Experience compiling NCQA File Review Universes and timeliness ... Qualifications** + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health. + Detailed working knowledge in… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- CDPHP (Albany, NY)
- …one (1) year clinical experience required. + A minimum of two (2) years quality/ utilization review experience in an HMO, managed care organization, or similar ... invites you to be a part of that experience. The Clinical Review and Coding Nurse is responsible to attain procedure and diagnosis coding accuracy and… more
- Bassett Healthcare (Cooperstown, NY)
- …discuss specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Dialysis units is accountable for the ... needs. The RN contributes to the support of patients through interdisciplinary teamwork. Registered Nurse I: The RN I status is only appropriate for a new nurse… more
- Bassett Healthcare (Cooperstown, NY)
- …with no more than 2-3 exceptions, as measured by random supervisory chart review and/or direct supervisory observation. The Registered Nurse II, Acute Care ... with no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation. The Registered Nurse II, Acute Care… more
- Albany Medical Center (Albany, NY)
- …Demonstrates experience in the referral process and use of community resources. 2. Utilization Review a. Reviews data from admission screening to clarify ... changing environment. 8. Basic knowledge of computer systems with skills applicable to utilization review process. Mission, Core Values and Service Excellence 1.… more
- Northwell Health (Bay Shore, NY)
- …of patients admitted to the Hospital. Job Responsibility + * Performs concurrent review on all patients and share all problematic cases with the Supervisor and ... retrospective reviews as required. + * Participates in the maintenance of Utilization Management, Discharge Planning and Case Management statistics as required. + *… more