- Evolent (Albany, NY)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Molina Healthcare (Albany, NY)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- CDPHP (Latham, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Trinity Health (Rensselaer, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** Nurse - RNII - Family Medical Group- Rensselaer If you are looking for an RN II position, ... Office hours What you will do: The Registered Professional Nurse has the responsibility and accountability to utilize the...room, takes appropriate vital signs and documents in electronic medical record. Review and update medication list… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Health, Department of Title Public Health Program Nurse (NY HELPS) - 07370 Occupational Category Health Care, Human/Social Services Salary Grade ... to support implementation of multiple infant health initiatives, and provide clinical insight and guidance on related activities. This includes public health… more
- Albany Medical Center (Albany, NY)
- …$0.00 - $0.00 Position Summary We are seeking a dedicated and compassionate Nurse Practitioner (NP) to join our academic home-based primary care practice, serving ... home visits, telehealth support, and the management of chronic and acute medical conditions, with a strong emphasis on geriatric syndromes, care coordination, and… more
- IQVIA (Albany, NY)
- Mobile Nurse Practitioner - Per Diem, In-Home Services **Location:** Various US locations (local travel within designated geographic area) **About the Role:** ... IQVIA's In-Home Clinical Solutions team seeks a qualified and dedicated Mobile Nurse Practitioner to support patient care by delivering in-home diagnostic… more
- Trinity Health (Albany, NY)
- …Cardiology Office - Albany, NY - FT - Days** If you are looking for a Clinical Nurse Manager position in an Outpatient Cardiology practice, this could be your ... allowance and career development **What you will do:** The Nurse Manager of Clinical Care is directly...ACLS certification + Minimum of ten years demonstrated professional clinical leadership. + Significant electronic medical record… more
- Trinity Health (Albany, NY)
- …Brings patient to exam room, takes appropriate vital signs and documents in electronic medical record. + Review and update medication list to ensure accurate and ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse - RNII -Cardiology Office - Phone Triage...complete list in electronic medical record (EMR) available for provider review … more
- CVS Health (Albany, NY)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …and record relevant] patient information. Completed work [should need] only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... condition, collecting objective and subjective data. Collaborating with the Registered Nurse /Provider in developing and implementing a plan of care individualized to… more
- CVS Health (Albany, NY)
- …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 ... requests. Works closely with leadership and Medical Director on member requests. This role is responsible...New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical … 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 ... benefits and more! GENERAL RESPONSIBILITIES: Using principles of Patient Centered Medical Home (PCMH), the Care Manager (RN) will demonstrate professional nursing… 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 ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- YesCare Corp (Coxsackie, NY)
- …a pioneer in correctional healthcare services, YesCare is committed to innovation, clinical expertise, and compassionate care. By choosing a career with YesCare, you ... + Work alongside physicians and interdisciplinary team members to initiate and review healthcare plans. + **Communication and Reporting:** + Act as a liaison… more
- Cardinal Health (Albany, NY)
- …to ensure a positive and satisfactory experience for all customers. The Supervisor, Clinical Operations monitors nurse to patient contact quality and provides ... manufacturers to rethink the reach and impact of their products. The Supervisor, Clinical Operations provides management and clinical oversight to a team of… more
- Fujifilm (Albany, NY)
- **Position Overview** The Clinical Consultant, MI - I shall be responsible for providing clinical consulting for the project, report configuration (CV), workflow ... go-live support to Synapse PACS/MI projects. In addition, provide clinical support for sales and company team members with...HCUS team to gain customer acceptance of the FUJIFILM Medical Systems solution. + Participates in teaching and training… more
- Molina Healthcare (Albany, NY)
- …records and other data in support of annual HEDIS project management and ongoing review of medical records submitted by providers. + Implements Molina Healthcare ... completion of any of the following programs: + Registered Nurse (RN) or State Licensed Vocational Nurse ... records collection and abstraction * 2+ years of medical record review experience **REQU** **I** **RED… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents cases in a consistent… more
- Molina Healthcare (Albany, NY)
- …, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members… more