- Cognizant (Albany, NY)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CDPHP (Latham, NY)
- …two (2) years of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + ... of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review...recognized criteria and CDPHP policies, and procedures. QUALIFICATIONS: + Registered Nurse with a current New York… more
- CVS Health (Albany, NY)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team.… more
- CVS Health (Albany, NY)
- …The schedule is Monday - Friday, 8:30am - 5pm EST. This role is a registered nurse that utilizes MCG rules and applies medical necessity guidelines to service ... within specific allowable turn around times. **Required Qualifications** + Registered Nurse with active and unrestricted New...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical… more
- CVS Health (Albany, NY)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Albany, NY)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …Former EDRP participants ineligible to apply. Responsibilities The Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based ... orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Trinity Health (Schenectady, NY)
- …to geriatrics recover from a stroke, traumatic injury or disabling illness. **Full Time Registered Nurse (RN) - Manager - Sunnyview Rehab Hospital - Brain ... friends, and families. + Serves as a resource, planner, clinical expert, manager and interdisciplinary coordinator. + Areas of...**What you will need:** + Current New York State Registered Professional Nurse licensure (The Program … 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 ... to identify patient for care coordination services. + Collaborate with providers/ clinical team members to identify target patient population for care coordination.… more
- Trinity Health (Troy, NY)
- …and perceiving our world and that these differences often lead to innovative solutions. ** Registered Nurse Professional Utilization Management Nurse - ... shifts to accommodate all schedules **What you will do:** + Perform utilization management, both concurrent and retroactive for inpatient and outpatient services in… more
- CDPHP (Latham, NY)
- …New York State license is required) + In lieu of behavioral health license, Registered Nurse with valid New York State license, with experience treating ... values and invites you to be a part of that experience. The BH Utilization Specialist is responsible for coordination of care for CDPHP members across the continuum,… more
- Evolent (Albany, NY)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... 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… more
- New York State Civil Service (Albany, NY)
- …in nursing AND current New York State license and registration as a professional registered nurse AND four years of post-licensure nursing experience. One year ... in nursing AND current New York State license and registration as a professional registered nurse AND three years of post-licensure nursing experience. One year… more
- Molina Healthcare (Albany, NY)
- …or equivalent combination of relevant education and experience. * Advanced Practice Registered Nurse (APRN) license. License must be active and unrestricted ... * At least 8 years of health care experience, including 5 years of clinical practice experience, 3 years utilization /quality program management experience, and 2… more
- Whitney Young Health Center (Albany, NY)
- …other duties as assigned. Requirements MINIMUM QUALIFICATIONS: + Graduate of a registered approved Nurse Practitioner/Physician Assistant Program + Completion of ... required State/National Certification Programs + Current licensure and registration as a Registered Professional Nurse /Physician Assistant in the State of New… more
- Molina Healthcare (Albany, NY)
- …on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree in ... on the job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree in… more
- Molina Healthcare (Albany, NY)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....or modification of payment decisions. * Serves as a clinical resource for utilization management, chief medical… more
- Sharecare (Albany, NY)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Molina Healthcare (Albany, NY)
- …for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and ... of Nursing **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or… more
- Ellis Medicine (Niskayuna, NY)
- …EDUCATION AND EXPERIENCE REQUIREMENTS: + Currently licensed in New York State as a Registered Nurse and a graduate of an approved school of nursing. + ... Join our team and GROW with Ellis! The Administrative Clinical Supervisor functions as the administrative manager during the... Supervisor will work collaboratively with the DON and Nurse Managers to assure effective and efficient utilization… more