- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- MVP Health Care (Schenectady, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...providers, facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization. + Document review … more
- Molina Healthcare (Albany, NY)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...to overarching strategy to provide quality and cost-effective member care . Candidates with UM and Appeals experience… more
- Humana (Albany, NY)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** The Care Review Clinician ( RN ) provides support for clinical member services review assessment processes. Responsible for verifying ... care . We are seeking a candidate with a RN licensure that has previous UM and...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Albany, NY)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Albany, NY)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Albany, NY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... other clinical programs. * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and… more
- Molina Healthcare (Albany, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional… more
- Molina Healthcare (Albany, NY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... other clinical programs. * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and… more
- Trinity Health (Troy, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Supervisor for NEW ED Observation Unit at Samaritan Hospital** **Pavilion Building - ... 4T** **EXEMPT** **FT Days** If you are an experienced RN looking for a **_leadership_** position in the Observation/Clinical...your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places. **Position Highlights:**… more
- MVP Health Care (Schenectady, NY)
- At MVP Health Care , we're on a mission to create a...bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case ... + An opportunity to shape the future of health care by joining a team recognized as a **Best...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
- Datavant (Albany, NY)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...bring to the table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred +… more
- Elevance Health (Latham, NY)
- **Behavioral Health Care Manager II** **Shift:** Friday - Monday; 8:00am - 7:00pm EST - Schedule may flex based on business needs **Location:** Virtual; within 50 ... is granted as required by law._ The **Behavioral Health Care Manager II** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more
- Highmark Health (Albany, NY)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more