- Molina Healthcare (Yonkers, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...providers, facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization. + Document review … more
- Molina Healthcare (Yonkers, NY)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to overarching strategy to provide quality and cost-effective member care . Candidates with UM and Appeals experience… more
- Molina Healthcare (Bronx, NY)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for clinical member services review assessment processes. Responsible for ... care . We are seeking a candidate with a RN licensure that has previous UM and...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Yonkers, 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 ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Yonkers, NY)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Yonkers, NY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... other clinical programs. * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and… more
- Molina Healthcare (Yonkers, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional… more
- Molina Healthcare (Yonkers, NY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... other clinical programs. * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and… more
- Centene Corporation (New York, NY)
- …of related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day… more
- MVP Health Care (Tarrytown, NY)
- At MVP Health Care , we're on a mission to create a...bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case ... + An opportunity to shape the future of health care by joining a team recognized as a **Best...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
- Elevance Health (Middletown, NY)
- **Behavioral Health Care Manager II** **Shift:** Friday - Monday; 8:00am - 7:00pm EST - Schedule may flex based on business needs **Location:** Virtual; within 50 ... is granted as required by law._ The **Behavioral Health Care Manager II** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... appeals for the purpose of securing reimbursement for acute care services provided to patients. Assist in development of...submission in appeal. - In absence of Director, will review denial correspondence to determine validity of denial reason… more