- 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
- Albany Medical Center (Albany, NY)
- …+ Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Critical Care Registered Nurse is responsible for providing competent, evidence-based care to patients with oversight of licensed vocational… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work assignments are… 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
- Molina Healthcare (Albany, NY)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are… 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
- Trinity Health (Albany, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Manager - Outpatient Cardiology Office - Albany, NY - FT - Days** If you are looking for ... a Clinical Nurse Manager position in an Outpatient Cardiology practice, this...evaluations, regularly scheduled program reviews, facility rounds and program utilization statistics. + Develops objective performance measures which differentiate… more
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Evolent (Albany, NY)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices...UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory… more
- Whitney Young Health Center (Albany, NY)
- Registered Nurse (RN) Care Manager (Req 100984) Albany, NY (http://maps.google.com/maps?q=920+Lark+Drive+Albany+NY+USA+12207) Apply Description Be a part of the ... management by focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient satisfaction. +… more
- CVS Health (Albany, NY)
- …through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and ... business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management Certification **Education** Associate Degree… more
- Molina Healthcare (Albany, NY)
- …care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Albany, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This… 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 of high ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician RN provides support for clinical member services review assessment processes. Responsible for verifying ... Hospital experience. Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in a high-volume environment.… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Molina Healthcare (Albany, NY)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the… more