- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Trinity Health (Troy, NY)
- …differences often lead to innovative solutions. **Registered Nurse Professional Utilization Management Nurse - St. Peter's Hospital--Full-TIme Days** ... to accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for inpatient and outpatient services in… more
- Trinity Health (Albany, NY)
- …in Albany, NY** is looking for an experienced RN to work as a Registered Professional Utilization Management Nurse (UMRN) per diem. The team is willing to ... **The selected candidate will** : + Be responsible for the utilization management , both concurrent and retroactive for inpatient and outpatient services in… more
- CDPHP (Latham, NY)
- …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... shift between 8 AM and 6 PM Eastern. The ** Utilization Management Representative I** is responsible for...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- CDPHP (Latham, NY)
- …care experience in a hospital setting required. + Minimum one (1) year quality/ utilization management experience in health care setting preferred. + Experience ... required) + In lieu of behavioral health license, Registered Nurse with valid New York State license, with experience...with utilization management software including Facets, Macess and… more
- Sharecare (Albany, NY)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… 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 ... appropriate LOS and financial constraints. + Provides collaborative care management with the primary nurse in assessing...assigned service - required + Recent experience in case management , utilization management and/or discharge… 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 ... EDRP participants ineligible to apply. Responsibilities The Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to… more
- Trinity Health (Schenectady, NY)
- …preferred or obtained within 2 years of hire. + Previous experience in nurse management required Our compassionate staff is there with up-to-the-minute treatment ... stroke, traumatic injury or disabling illness. **Full Time Registered Nurse (RN) - Manager - Sunnyview Rehab Hospital -...30 out of 1100+ rehab hospitals has a wonderful management opportunity! We at St. Peter's Health Partners recognize… more
- Molina Healthcare (Albany, NY)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- Molina Healthcare (Albany, NY)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… 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...as appropriate governmental and other regulatory standards. Insures clinical management presence during working hours. + Ensures timely performance… more
- Elevance Health (Latham, NY)
- …required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… 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 ... professional nursing practice, excellent communication and critical thinking skills, self- management expertise along with outstanding customer service to promote and… more
- Trinity Health (Albany, NY)
- … Management :** + Direct daily operations, ensuring efficient resource utilization , staffing, and workflow optimization. + Oversee budgeting, resource allocation, ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Director for Cardiovascular Service Line Surgical at...and financial management to achieve cost-effectiveness and profitability. + Ensure compliance… more
- Molina Healthcare (Albany, NY)
- …Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). LVN (Licensed Vocational Nurse ) or ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Molina Healthcare (Albany, NY)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Molina Healthcare (Albany, NY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more