- MVP Health Care (Rochester, NY)
- …years of clinical nursing experience At least 2 years of experience in utilization management of sub-acute Medicare reviews Experience with Medicare guidelines ... To achieve this, we're looking for a Professional, Sub-Acute RN UM Reviewer - Medicare to join...interdisciplinary teams to ensure optimal patient care and resource utilization . Document review outcomes and maintain compliance… more
- MVP Health Care (Rochester, NY)
- …you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months after ... in every interaction Your key responsibilities: Utilize the essentials of an integrated utilization management and case management model that includes… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- MVP Health Care (Rochester, NY)
- …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join...interdisciplinary teams to ensure optimal patient care and resource utilization . + Document review outcomes and maintain… more
- Molina Healthcare (Rochester, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred… more
- Molina Healthcare (Rochester, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing....Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and… more
- Molina Healthcare (Rochester, NY)
- … and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical...payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, physicians and… more
- Fresenius Medical Center (Batavia, NY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory ... varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist,… more
- Molina Healthcare (Rochester, NY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- Rochester Regional Health (Rochester, NY)
- …Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education ... Management Data base to support the clinical review process. + Concurrently monitors resources utilization ,...required + Licensed in New York State as a Registered Nurse + For hires after 10/28/2024,… more
- Veterans Affairs, Veterans Health Administration (Batavia, NY)
- …to apply. Responsibilities The Batavia VA Medical Center is seeking a qualified full-time Registered Nurse ( RN ) to join Long-term care in the Community ... applicants will be considered and referred as vacancies become available. The CLC Registered Nurse is responsible and accountable for all elements of the… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse Case Manager IIDepartment: Home Care Location: West Monroe Hours Per Week: 40Schedule: Days SUMMARY:The RN Case Manager is ... + Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. +… more
- Molina Healthcare (Rochester, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- MVP Health Care (Rochester, NY)
- …you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after ... key responsibilities:** + Utilize the essentials of an integrated utilization management and case management ...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
- University of Rochester (Rochester, NY)
- …- Quality Assurance and Process Improvement (QA/PI) experience preferred LICENSES AND CERTIFICATIONS - RN - Registered Nurse - State Licensure and/or Compact ... primary internal contact for national and state registry data management questions, issues or concerns, but not limited to...State Licensure Current licensure as a Registered Nurse in NYS upon hire required… more
- DePaul (Rochester, NY)
- …Quality Management planning. + Performs all other duties as assigned. Qualifications + Registered Nurse or Licensed Practical Nurse with 3 years of ... Management Plan within the corporation. + Incident Management - review incident reports and provide...reporting and follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual… more
- Rochester Regional Health (Rochester, NY)
- …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Nurse Manager, Ambulatory ServicesDepartment: Pulmonary, Sleep Lab, Infectious...of Nursing and Director of Quality to provide quality review activities. Guides assigned areas in utilization … more
- University of Rochester (Rochester, NY)
- …Technician (RHIT) Program **_or_** + Licensure/credentials in clinical specialty such as Registered Nurse , Licensed Practical Nurse , or Emergency Medical ... requests, and external oversight: ie) NYS DOH, ACS Committee on Trauma Registry Management : + Monitor security of data to ensure the integrity and reliability of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …attendance is expected and required. + Performs other functions as assigned by management . Minimum Qualifications: + RN with current New York State license ... + In collaboration with the Lead Medical Policy Coordinators, tracks the annual review requirements of assigned policies ensuring all annual reviews are completed in… more
