- Cognizant (Trenton, NJ)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... member's - ages 0-18.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact… more
- City of New York (New York, NY)
- …required; make professional recommendations accordingly. - Keep abreast of medical and utilization review techniques and developments relative to the nursing ... Nurse in the Bureau of Medical and Professional Review (BMPR) of Home Care Services Program. As the...- 50935 Qualifications 1. A valid New York State Registered Nurse License and completion of one… more
- Centene Corporation (New York, NY)
- …of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required ... Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team… more
- Veterans Affairs, Veterans Health Administration (New York, NY)
- …certification in Mental Health or Psychiatry Nursing 2-3 years as a mental health outpatient registered nurse in an acute care medical center and/or 2-3 years in ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- CVS Health (Trenton, NJ)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Atlantic Health System (Basking Ridge, NJ)
- …Visiting Nurse , part of Atlantic Health System, is seeking a full-time hospice Registered Nurse to work 8AM- 4PM in the Somerset County area, including ... of care for the patient and family Ensures appropriate utilization of services + Maintains visit productivity standards +...Program- Associates Degree 2. Current state licensure as a Registered Nurse . 3. BLS certification. Preferred: 1.… more
- Chatham Hills Subacute Care Center (Chatham, NJ)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... a week 37.5 - 40 hours per week Respiratory Nurse (RN) We are searching for a highly motivated,...communications within the facility with the director of nursing, nurse managers, and admissions coordinator to assist in development… more
- Centene Corporation (New York, NY)
- …+ LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: $26.50 - $47.59 per hour Centene ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Fresenius Medical Center (Staten Island, 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 (Staten Island, 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
- Centene Corporation (New York, NY)
- …+ LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: $26.50 - $47.59 per hour Centene ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- Mount Sinai Health System (New York, NY)
- …Additional Detail** + Licensure: New York State License with current registration as a registered nurse . + State Certification: Certified by the New York State ... the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion...follows: a. Is a graduate of New York State registered Nurse Practitioner Program or equivalent OR… more
- Mount Sinai Health System (New York, NY)
- …Additional Detail** 1. Licensure: New York State License with current registration as a registered nurse . 2. State Certification: Certified by the New York State ... the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion...follows: a. Is a graduate of New York State registered Nurse Practitioner Program or equivalent OR… more
- Mount Sinai Health System (New York, NY)
- …REQUIREMENTS** 1. Licensure: New York State License with current registration as a registered nurse . 2. State Certification: Certified by the New York State ... follows: 3. Is a graduate of New York State registered Nurse Practitioner Program or equivalent OR...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- City of New York (New York, NY)
- …requirement above, candidates must have three years of full-time satisfactory experience as a Registered Nurse , two of which must have been in a supervisory ... with the referring agency and the client's caseworker. 2. Review all available clinically relevant material, including referral information,...have three years of full-time satisfactory experience as a Registered Nurse , one of which must have… more
- Sharecare (Trenton, NJ)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Hackensack Meridian Health (Edison, NJ)
- …systems; Google Docs, EPIC. **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP ... and its Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review procedures. + Knowledge of Social Determinants… more
- Mount Sinai Health System (New York, NY)
- …patient emergencies and supporting patient-centered care. **Qualifications** Must be a Licensed Registered Nurse , Physician Assistant or Nurse Practitioner ... of Patient Flow experience preferred 5. EPIC experience preferred. Registered Nurse Licensed NYS Registered ...8 hospitals and over 95 inpatient units. Promotes optimum utilization of system hospital beds by conducting rounds and… more
- Northwell Health (Staten Island, NY)
- …case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. + Keeps ... utilization management using Interqual criteria. + Conducts chart review for appropriateness of admission and continued length of...Nursing, required. + Current license to practice as a Registered Professional Nurse in New York State.… more