- Albany Medical Center (Albany, NY)
- …Management /Social Work Work Shift: Day (United States of America) Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. Salary: $65,062.40 - $107,348.80 * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to… more
- Albany Medical Center (Albany, NY)
- …works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to ... with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use...Basic knowledge of computer systems with skills applicable to utilization review process. Thank you for your… more
- Elevance Health (Latham, NY)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA Albany Healthcare System's mission is… more
- New York State Civil Service (Menands, NY)
- …rehabilitation, medical/surgical, public health, community health, visiting nursing, occupational health, utilization review , or review of medical records ... NY HELP Yes Agency Workers' Compensation Board Title Registered Nurse 2 (Medical Care) (NY HELPS), WCB Item #2346...of Resolution for all assigned prior authorization requests.* Medical review and preparation of files for disputed medical bill… more
- Trinity Health (Troy, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Manager - Vascular Surgery Offices - Capital Region - FT** If you are looking for a ... program, generous tuition allowance and career development **What you will do:** The Nurse Manager of Clinical Care is directly responsible for the daily supervision… more
- Sedgwick (Albany, NY)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- CenterWell (Pittsfield, MA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Highmark Health (Albany, NY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Albany Medical Center (Albany, NY)
- …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... ensure compliance with all regulatory standards. + Planning and Program Management : + Provides administrative direction and coordination in the formulation,… more
- Albany Medical Center (Albany, NY)
- …years in health care, involving benchmarking of data. + Demonstrated progressive management experience, minimum 3-5 years. Skills, Knowledge & Abilities: + Knowledge ... of Workday and Epic is preferred, or knowledge of a similar material management system is required. + Able to communicate effectively at all levels within the… more
- Albany Medical Center (Albany, NY)
- …to their visit and overall health and wellness + Knowledge in case management , utilization management and/or discharge planning preferred. + Demonstrates ... States of America) Salary range: $68,640 - $99,023 Registered Nurse (RN) - Full Time Ear, Nose, and Throat...or APP and documents results in EHR + Performs review and triage of incoming test results, patient requests… more
- Albany Medical Center (Albany, NY)
- …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... ensure compliance with all regulatory standards. Planning and Program Management : Provides administrative direction and coordination in the formulation,… more
- Trinity Health (Albany, NY)
- …Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals of patients at St. Peter's Hospital referred for subacute ... is to provide on-site support and assistance to hospital case management and hospitalist team to ensure timely identification of inpatients appropriate… more
- CDPHP (Albany, NY)
- …(3) years of clinical experience required. + Minimum one (1) year of quality/ utilization review experience required. + Experience with research, data retrieval, ... clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations about appropriateness of care,… more