- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- Trinity Health (Albany, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse , physicians, staff and ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified… more
- CVS Health (Albany, NY)
- …Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of behavioral ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN) supports daily coordination of care across healthcare continuum with the healthcare team, ... responsible for preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN ensures the appropriate level of… more
- Elevance Health (Latham, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Virtual:** This role enables...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- Summary The Albany VAMC is looking to fill (1) Registered Nurse - ACCREDITATION QUALITY SPECIALIST position. You will be expected to travel for this position. You ... with driving requirements for this position. Responsibilities The Registered Nurse Accreditation Quality Specialist executes leadership that is characterized by… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- CVS Health (Albany, NY)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Albany, NY)
- …with transferring patients to lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation preferred - 1+ ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Albany, NY)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department ...Excel, and Outlook - Active and unrestricted Licensed Practical Nurse (LPN) in NY or PA - Hospice/palliative care… more
- Sharecare (Albany, NY)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- MVP Health Care (Schenectady, NY)
- Hospital Case Manager - Registered Nurse (RN) 625 State St, Schenectady, NY 12305, USA Req #2261 Monday, May 19, 2025 At MVP Health Care, we're on a mission to ... + Current New York State Licensure as a Registered Nurse required with at least 4 years of recent...confidentiality. + Ability to make independent decisions regarding resource utilization , and quality of care. + Must demonstrate understanding… more
- Trinity Health (Latham, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Manager - Orthopedics Office - Latham, NY** If you are looking for a Clinical Nurse ... evaluations, regularly scheduled program reviews, facility rounds and program utilization statistics. + Develops objective performance measures which differentiate… more
- Fresenius Medical Center (Amsterdam, NY)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (Saratoga Springs, 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
- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- Molina Healthcare (Albany, 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
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly...transition of care with Social Worker + Serves as nurse consultant for Social Worker cases with Clinical or… more