- 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
- 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
- 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
- MVP Health Care (Rochester, NY)
- …+ Minimum 4 years of clinical nursing experience. + At least 2 years in utilization management sub-acute care review . + 2+ years of supervisory experience ... To achieve this, we're looking for a **Leader, Concurrent Review ** to join #TeamMVP. If you have a passion...**Qualifications you'll bring:** + Current and unrestricted NY, VT RN license. + Associate or bachelor's degree in nursing… more
- Villa of Hope (Rochester, NY)
- …JOB SUMMARY: Under the general direction of the Nurse Manager, the Intake Coordinator- RN is a Registered Nurse who will assist in supervising Clinical ... director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and...or leaving against medical advice. MINIMUM QUALIFICATIONS: + NYS Registered Nurse license + Bachelor degree preferred… 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