- Albany Medical Center (Albany, NY)
- Department/Unit: Care Management /Social Work Work Shift: Day (United States of America) Utilization Review Nurse Salary Range: $31.28 - $51.61 per hour ... Responsible for Utilization Management , Quality Screening and Delay ...Basic knowledge of computer systems with skills applicable to utilization review process. + Excellent written and… more
- 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 ... for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge… more
- Albany Medical Center (Albany, NY)
- …Management /Social Work Work Shift: Day (United States of America) Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. Salary: $65,062.40 - $107,348.80 * Completes Utilization Management and Quality Screening for assigned patients. * Applies MCG criteria to… more
- Elevance Health (Latham, NY)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- CDPHP (Albany, NY)
- …one (1) year clinical experience required. + A minimum of two (2) years quality/ utilization review experience in an HMO, managed care organization, or similar ... to be a part of that experience. The Clinical Review and Coding Nurse is responsible to...management /cost containment issues preferred. + Demonstrated ability to review health care delivery against established criteria. + Demonstrated… more
- Albany Medical Center (Albany, NY)
- …proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to ... appropriate LOS and financial constraints. c. Provides collaborative care management with the primary nurse in assessing...the referral process and use of community resources. 2. Utilization Review a. Reviews data from admission… more
- Elevance Health (Latham, NY)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …determined by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities The duties of the RN include, ... but are not limited to: Demonstrates ability to function effectively in charge nurse , team leader, or other leadership roles. Applies problem-solving skills at the… more
- Fresenius Medical Center (Troy, 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
- Marriott (Albany, NY)
- …with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer catastrophic cases in coordination with claims ... claims most likely to benefit from case management to meet jurisdictional needs. ** Utilization Review ** + Provide initial clinical review in order to… more
- CenterWell (Clifton Park, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Albany Medical Center (Albany, NY)
- …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... ensure compliance with all regulatory standards. + Planning and Program Management : + Provides administrative direction and coordination in the formulation,… more
- Albany Medical Center (Albany, NY)
- …years in health care, involving benchmarking of data. + Demonstrated progressive management experience, minimum 3-5 years. Skills, Knowledge & Abilities: + Knowledge ... of Workday and Epic is preferred, or knowledge of a similar material management system is required. + Able to communicate effectively at all levels within the… more
- CDPHP (Albany, NY)
- …with Medicaid Long Term Care Programs preferred. + Minimum of two (2) years Utilization Management experience is preferred. + Experience with the New York State ... Programs RN Case Manager and the success of the member-focused Complex Case Management Programs. QUALIFICATIONS: + Registered Nurse with a current New York… more
- Trinity Health (Albany, NY)
- …Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals of patients at St. Peter's Hospital referred for subacute ... is to provide on-site support and assistance to hospital case management and hospitalist team to ensure timely identification of inpatients appropriate… more