- CDPHP (Latham, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- Albany Medical Center (Albany, NY)
- …+ Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more
- Cognizant (Albany, NY)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Elevance Health (Latham, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Virtual:** This role enables...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Bassett Healthcare (Cobleskill, NY)
- …discuss specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Emergency Department 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)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Critical Care Registered Nurse is responsible for providing competent, evidence-based care to patients with oversight of licensed vocational… more
- Bassett Healthcare (Cobleskill, NY)
- …enjoy the best quality of life possible. What you'll do The Registered Professional Nurse II, Acute Care is accountable for the delivery of safe patient care ... no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. + Analyzes assessment data… more
- Bassett Healthcare (Cobleskill, NY)
- …enjoy the best quality of life possible. What you'll do The Registered Professional Nurse I, Acute Care is accountable for the delivery of safe patient care ... and job description is only appropriate for a new nurse in the first year of practice, as support...than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. +… more
- New York State Civil Service (Albany, NY)
- …experience include but are not limited to: Experience in discharge planning, utilization review , treatment plan development for individuals in community or ... Yes Agency Health, Department of Title Public Health Program Nurse (NY HELPS) - 47963 Occupational Category Administrative or...Description This posting is for a Public Health Program Nurse (PHPN) Position in the Bureau of Perinatal, Reproductive,… 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 ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Molina Healthcare (Albany, NY)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are… 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...evaluations, regularly scheduled program reviews, facility rounds and program utilization statistics. + Develops objective performance measures which differentiate… 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 ... 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
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Evolent (Albany, NY)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices...UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory… 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 ... management by focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient satisfaction. +… more
- CVS Health (Albany, NY)
- …through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and ... business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management Certification **Education** Associate Degree… more
- Molina Healthcare (Albany, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more