- Centene Corporation (New York, NY)
- …clinical license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Penn Medicine (Plainsboro, NJ)
- …+ Coordinates discharge planning and communicates plan clearly to patient, family and Utilization Review Nurse , Financial Counselor and outpatient treatment ... + Communicate effectively the essential clinical features of each case with utilization reviewers and monitors patient attendance in scheduled program and length of… more
- New York State Civil Service (New York, NY)
- …Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 Occupational Category Health Care, Human/Social Services ... York State NY Zip Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily … more
- New York State Civil Service (New York, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Manhattan Psychiatric Center, P27078 Occupational Category Health ... Code 10035 Duties Description Manhattan Psychiatric Center is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title: Nurse Practitioner-Cardiovascular Institute - Mount Sinai Hospital- Full Time - Day (7:30am - 4:00pm) 5 days/week** A nurse ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (Long Island City, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- City of New York (New York, NY)
- …required; make professional recommendations accordingly. - Keep abreast of medical and utilization review techniques and developments relative to the nursing ... Medicaid Eligibility Unit is responsible for the Medicaid eligibility review and processing of initial applications, change actions, and...Nurse in the Bureau of Medical and Professional Review (BMPR) of Home Care Services Program. As the… more
- Fresenius Medical Center (New York, NY)
- …and programs. Collaborates with the Medical Director and the Clinical Coordinator /Charge Nurse or Nurse Supervisor regarding the provision of quality patient ... closely with, providing oversight as needed to, the Clinical Coordinator/Charge RN or Nurse Supervisor acting as nurse manager, the Medical Director, and the… more
- City of New York (New York, NY)
- …CAS Visiting Psychiatric Services (VPS) Unit is recruiting for two (2) Psychiatric Nurse Practitioner for the roles below. Under the supervision of the Medical ... for independent judgement within NYS licensing guidelines, the VPS Psychiatric Nurse Practitioner is responsible for performing psychiatric evaluations of clients at… more
- Veterans Affairs, Veterans Health Administration (New York, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Surgical Intensive Care Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned patients and oversight of… more
- Penn Medicine (Plainsboro, NJ)
- …Are you living your life's work? Summary: + A registered professional nurse responsible for visioning, overseeing, planning, organizing, evaluating and management of ... the following areas: Unit Budget Quality Improvement Plan Resource Utilization Human Resource Management Master Unit Staffing Plan Unit Risk Management Patient… more
- Elevance Health (Woodbridge, NJ)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- Hackensack Meridian Health (Edison, NJ)
- …New Jersey program and its Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review procedures. + Knowledge of ... EPIC. **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP Certification. **Licenses… more
- Centene Corporation (New York, NY)
- …applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA ... of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical… more
- Mount Sinai Health System (New York, NY)
- …+ Experience Requirements + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... are not limited to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Mount Sinai Health System (New York, NY)
- …The Clinical Program Manager, Clinical Command Center is a Registered Professional Nurse , Physician Assistant, or Nurse Practitioner, who manages the 24 ... and supporting patient-centered care. **Qualifications** Must be a Licensed Registered Nurse , Physician Assistant or Nurse Practitioner Registered Nurse… more
- Mount Sinai Health System (New York, NY)
- …in the Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators ... **Job Description** The Director of Nursing Professional Practice is a professional nurse with broad knowledge and skill in the professional practice standards, NYS… more