- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- MVP Health Care (Rochester, NY)
- …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join...interdisciplinary teams to ensure optimal patient care and resource utilization . + Document review outcomes and maintain… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory ... varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist,… more
- Molina Healthcare (Rochester, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred… more
- Molina Healthcare (Rochester, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing....Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and… more
- Molina Healthcare (Rochester, 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...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Molina Healthcare (Rochester, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday… more
- Fresenius Medical Center (Batavia, 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
- Rochester Regional Health (Rochester, NY)
- …Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education ... Management Data base to support the clinical review process. + Concurrently monitors resources utilization ,...required + Licensed in New York State as a Registered Nurse + For hires after 10/28/2024,… more
- Molina Healthcare (Rochester, 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 ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Veterans Affairs, Veterans Health Administration (Batavia, NY)
- …to apply. Responsibilities The Batavia VA Medical Center is seeking a qualified full-time Registered Nurse ( RN ) to join Long-term care in the Community ... applicants will be considered and referred as vacancies become available. The CLC Registered Nurse is responsible and accountable for all elements of the… more
- Molina Healthcare (Rochester, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Care Review Clinician RN provides support for...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse Case Manager IIDepartment: Home Care Location: West Monroe Hours Per Week: 40Schedule: Days SUMMARY:The RN Case Manager is ... + Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. +… more
- Molina Healthcare (Rochester, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... SUMMARY As a Registered Nurse - Care Manager, your...+ Three (3) years of acute hospital care, case management or utilization management experience… more
- MVP Health Care (Rochester, NY)
- …you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after ... key responsibilities:** + Utilize the essentials of an integrated utilization management and case management ...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
- MVP Health Care (Rochester, NY)
- …Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse ( RN ) required + New York State license required ... The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance...with at least 2 years being ASD related + Utilization or Case Management experience in a… more
- Villa of Hope (Rochester, NY)
- …JOB SUMMARY: Under the general direction of the Nurse Manager, the Intake Coordinator- RN is a Registered Nurse who will assist in supervising Clinical ... director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and...or leaving against medical advice. MINIMUM QUALIFICATIONS: + NYS Registered Nurse license + Bachelor degree preferred… more
- University of Rochester (Rochester, NY)
- …- Quality Assurance and Process Improvement (QA/PI) experience preferred LICENSES AND CERTIFICATIONS - RN - Registered Nurse - State Licensure and/or Compact ... primary internal contact for national and state registry data management questions, issues or concerns, but not limited to...State Licensure Current licensure as a Registered Nurse in NYS upon hire required… more