- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Atlantic Health System (Hackettstown, NJ)
- …chart documentation. 8. Incorporates use of criteria sets in context of utilization management. 9. Performs other related duties as assigned. Required: 1. Master's ... - Becker's Healthcare + 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 - AARP + Gold-Level "Well… more
- Atlantic Health System (Newton, NJ)
- …process clinical referrals + Obtain insurance authorizations and participate in utilization reviews + Complete timely and accurate documentation utilizing Electronic ... - Becker's Healthcare + 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 - AARP + Gold-Level "Well… more
- Molina Healthcare (New York, NY)
- …in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS… more
- Molina Healthcare (New York, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS… more
- Molina Healthcare (New York, NY)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... transplants; the ideal candidate will have experience either in utilization review or case management for transplants....an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high… more
- Prime Healthcare (Boonton Township, NJ)
- …meetings as required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential services/programs ... of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging… more
- Educational Alliance, Inc. (New York, NY)
- …active participation on the Performance Improvement Committee + Monitor and support Utilization Review and authorizations for treatment to ensure current ... clinical insight and expertise + Facilitate the integration of behavioral , clinical and ancillary counseling staff in the part...of up to 10 cases in absence of a clinician + Provide clients with individual and group counseling… more