- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Veterans Affairs, Veterans Health Administration (Canandaigua, NY)
- …of Assigned Duties: The Registered Nurse Community Care (CC) Coordinator Registered Nurse ( RN ) is responsible for executing a streamlined approach to ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- MVP Health Care (Rochester, NY)
- Hospital Case Manager - Registered Nurse ( RN ) Rochester, NY, USA Req #2611 Monday, May 19, 2025 At MVP Health Care, we're on a mission to create a healthier ... bring:** + Current New York State Licensure as a Registered Nurse required with at least 4...at least 4 years of recent clinical and Care Management experience. + Certification in Case Manager (CCM) is… more
- Molina Healthcare (Rochester, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- Fresenius Medical Center (Rochester, NY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory ... varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist,… more
- Rochester Regional Health (Rochester, NY)
- …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... navigation for patients, including triage management , algorithm management , utilization management and resource...after admission-within the first 12 to 24 hours. Applies utilization review criteria to assess and document… more
- Rochester Regional Health (Rochester, NY)
- …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Management Data base to support the clinical review process. + Concurrently monitors resources utilization ,...Certification/Licensure + Licensed in New York State as a Registered Nurse Required Years of Experience +… more
- Rochester Regional Health (Rochester, NY)
- …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... navigation for patients, including triage management , algorithm management , utilization management and resource...after admission-within the first 12 to 24 hours. Applies utilization review criteria to assess and document… more
- Molina Healthcare (Rochester, NY)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... authorization requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference… more
- Molina Healthcare (Rochester, NY)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- MVP Health Care (Rochester, NY)
- …you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after ... key responsibilities:** + Utilize the essentials of an integrated utilization management and case management ...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
- Villa of Hope (Rochester, NY)
- …JOB SUMMARY: Under the general direction of the Nurse Manager, the Intake Coordinator- RN is a Registered Nurse who will assist in supervising Clinical ... director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and...or leaving against medical advice. MINIMUM QUALIFICATIONS: + NYS Registered Nurse license + Bachelor degree preferred… more
- University of Rochester (Rochester, NY)
- …- Quality Assurance and Process Improvement (QA/PI) experience preferred LICENSES AND CERTIFICATIONS - RN - Registered Nurse - State Licensure and/or Compact ... primary internal contact for national and state registry data management questions, issues or concerns, but not limited to...State Licensure Current licensure as a Registered Nurse in NYS upon hire required… more
- Molina Healthcare (Rochester, NY)
- …years Training & Education **Preferred License, Certification, Association** Active and unrestricted Registered Nurse ( RN ) license and Certified Coding ... assurance, or recovery auditing, ideally in a DRG/ Clinical Validation * 3+ years of Utilization Review and/or Medical Claims Review experience. * 3+ years… more
- Rochester Regional Health (Rochester, NY)
- …complete documentation per agency standard and program standard. Participates in utilization review and/or continuous quality improvement activities as ... LOCATION: Monroe County STATUS: Full Time Days SUMMARY The RN - Geriatric Case Manager, Home Care is responsible...the solutions of more complex issues/activities. Required Qualifications: * Registered Nurse license in New York State.… more