- CDPHP (Latham, 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 ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Albany Medical Center (Albany, NY)
- …+ Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more
- Cognizant (Albany, NY)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- CVS Health (Albany, NY)
- … with active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications** + ... every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York**...8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity… more
- Elevance Health (Latham, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Virtual:** This role enables...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Bassett Healthcare (Cobleskill, NY)
- …discuss specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Emergency Department 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
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support ... communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments… more
- Bassett Healthcare (Cobleskill, NY)
- …enjoy the best quality of life possible. What you'll do The Registered Professional Nurse II, Acute Care is accountable for the delivery of safe patient care ... no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. + Analyzes assessment data… more
- Bassett Healthcare (Cobleskill, NY)
- …enjoy the best quality of life possible. What you'll do The Registered Professional Nurse I, Acute Care is accountable for the delivery of safe patient care ... and job description is only appropriate for a new nurse in the first year of practice, as support...than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. +… more
- New York State Civil Service (Albany, NY)
- …experience include but are not limited to: Experience in discharge planning, utilization review , treatment plan development for individuals in community or ... NY HELP Yes Agency Health, Department of Title Public Health Program Nurse (NY HELPS) - 07370 Occupational Category Health Care, Human/Social Services Salary Grade… more
- New York State Civil Service (Albany, NY)
- …experience include but are not limited to: Experience in discharge planning, utilization review , treatment plan development for individuals in community or ... Yes Agency Health, Department of Title Public Health Program Nurse (NY HELPS) - 47963 Occupational Category Administrative or...Description This posting is for a Public Health Program Nurse (PHPN) Position in the Bureau of Perinatal, Reproductive,… 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 ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Elevance Health (Latham, NY)
- …4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of education ... is granted as required by law. The **Medical Management Nurse ** is responsible for review of the...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer skills. For… more
- Molina Healthcare (Albany, NY)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are… more
- CVS Health (Albany, NY)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Sharecare (Albany, NY)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Manager - Outpatient Cardiology Office - Albany, NY - FT - Days** If you are looking for ... a Clinical Nurse Manager position in an Outpatient Cardiology practice, this...evaluations, regularly scheduled program reviews, facility rounds and program utilization statistics. + Develops objective performance measures which differentiate… more
- Elevance Health (Latham, NY)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Whitney Young Health Center (Albany, NY)
- Registered Nurse (RN) Care Manager (Req 100984) Albany, NY (http://maps.google.com/maps?q=920+Lark+Drive+Albany+NY+USA+12207) Apply Description Be a part of the ... management by focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient satisfaction. +… more