- Independent Health (Buffalo, NY)
- …perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review ... clinical experience as an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care… more
- Catholic Health (Buffalo, NY)
- …with Weekend and Holiday Rotation Hours: 7:00pm to 7:00am Summary: The Nurse Residency position offers training, education and professional development through a six ... encompasses the Emergency Department (ED), Intensive Care Unit (ICU). The nurse resident systematically and continuously assists in the collection and assessment… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... New York VA Medical Center is seeking a Registered Nurse to work Full Time (Nights) in the Intensive...staff in addressing ethical issues Identifies and assesses resource utilization and safety issues, taking appropriate action Acquires knowledge… more
- Molina Healthcare (Buffalo, 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
- Catholic Health (Kenmore, NY)
- …(2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or ... Weekend and Holiday Rotation Hours: 0800-1800 Summary: The Registered Nurse (RN) Care Manager-Transition of Care, as an active...Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New… more
- Molina Healthcare (Buffalo, NY)
- …care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Buffalo, NY)
- …who must be licensed for the state they reside This role will be doing Utilization review for our Ohio Medicaid population, looking for clinicians with strong ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Buffalo, 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
- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This… more
- Molina Healthcare (Buffalo, NY)
- 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 ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Buffalo, NY)
- **JOB DESCRIPTION** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for verifying that ... Hospital experience. Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in a high-volume environment.… more
- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Molina Healthcare (Buffalo, NY)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more
- Molina Healthcare (Buffalo, NY)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Kaleida Health (Buffalo, NY)
- …2 years of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interquel Criteria set ... with members of the interdisciplinary team to coordinate care, facilitate utilization and resource management and discharge planning functions, working to achieve… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …Part II, Appendix G. The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical… more
- Kaleida Health (Buffalo, NY)
- …In addition to daily oversight of operations, the VP will partner with Utilization Review , Revenue Cycle, and Clinical leadership to create patient/family ... **Job Description** **The Vice President (VP) role supports the system Chief Nurse Executive (CNE) in providing executive leadership and guidance for critical areas… more
- STG International (West Seneca, NY)
- …* Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... and orientation of clinical staff physicians, physician assistants and nurse practitioners. * Collaborate with the CBOC Clinic Manager...61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse Corps - 66B,66H, 66P Medical Service Corps -… more