- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Albany, NY)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST/CST zones… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Trinity Health (Troy, NY)
- …differences often lead to innovative solutions. **Registered Nurse Professional Utilization Management Nurse - St. Peter's Hospital--Full-TIme TRACK ... to accommodate all schedules **What you will do:** + Perform utilization management , both concurrent and retroactive for inpatient and outpatient services in… more
- Cognizant (Albany, NY)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG...Triad Team and health care team. Minimum Qualifications:* Registered nurse with a New York State current license.* Bachelor's… more
- CDPHP (Latham, NY)
- …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- CVS Health (Albany, NY)
- …experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal ... clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data… more
- Albany Medical Center (Albany, NY)
- …works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to ... appropriate LOS and financial constraints. + Provides collaborative care management with the primary nurse in assessing...assigned service - required + Recent experience in case management , utilization management and/or discharge… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …EDRP participants ineligible to apply. Responsibilities The Critical Care Registered Nurse is responsible for providing competent, evidence-based care to patients ... of licensed vocational nurses/nursing assistants as appropriate to the setting. The nurse will assist in directing the provision of nursing education, orientation,… more
- New York State Civil Service (Albany, NY)
- NY HELP Yes Agency Health, Department of Title Public Health Program Nurse (NY HELPS) - 47963 Occupational Category Administrative or General Management Salary ... Code 12237 Duties Description This posting is for a Public Health Program Nurse (PHPN) Position in the Bureau of Perinatal, Reproductive, and Sexual Health (BPRASH).… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Nurse Manager (NM) actualizes the vision, mission and values for Ellis Medicine and maintains standards of the practice for nursing as defined by ... Standards of Practice and Nursing's social Policy Statement. The Nurse Manager participates in performance improvement/research activities; maintains professional… 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 ... EDRP participants ineligible to apply. Responsibilities The Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to… more
- Bassett Healthcare (Cobleskill, NY)
- …Schoharie County and the surrounding region What you'll do The Registered Professional Nurse (RN), Acute Care in the Medical Inpatient Unit is accountable for the ... needs. The RN contributes to the support of patients through interdisciplinary teamwork. + Registered Nurse I: The RN I status is only appropriate for a new nurse… more
- Molina Healthcare (Albany, NY)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and… more
- Molina Healthcare (Albany, NY)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… 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...as appropriate governmental and other regulatory standards. Insures clinical management presence during working hours. + Ensures timely performance… more
- Highmark Health (Albany, NY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Latham, NY)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more