- Molina Healthcare (Albany, NY)
- …Experience** 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… more
- Molina Healthcare (Albany, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high… more
- Molina Healthcare (Albany, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice.… more
- Molina Healthcare (Albany, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... managed care, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice.… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG...Triad Team and health care team. Minimum Qualifications:* Registered nurse with a New York State current license.* Bachelor's… 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)
- …EDRP participants ineligible to apply. Responsibilities The Critical Care Registered Nurse is responsible for providing competent, evidence-based care to patients ... of licensed vocational nurses/nursing assistants as appropriate to the setting. The nurse will assist in directing the provision of nursing education, orientation,… more
- Molina Healthcare (Albany, NY)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Bassett Healthcare (Cobleskill, NY)
- …Schoharie County and the surrounding region What you'll do The Registered Professional Nurse (RN), Acute Care in the Medical Inpatient Unit 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
- 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
- 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
- Highmark Health (Albany, NY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … 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
- 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
- Evolent (Albany, NY)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... is 11:30-8:00 eastern** **OTHER SKILLS and ABILITIES:** Strong clinical, management , communication, and organizational skills. Demonstrated leadership skills Analytic… 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
- Molina Healthcare (Albany, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in...emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
