- 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...acute care experience is required as a Licensed Practical Nurse . + Minimum of two (2) years Utilization… more
- 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)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Salary… more
- Lincoln Financial Group (Albany, NY)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Elevance Health (Latham, NY)
- **Anticipated End Date:** 2024-09-11 **Position Title:** Licensed Utilization Review I **Job Description:** The **Licensed Utilization Review I** is ... and a minimum of 2 years of clinical or utilization review experience; or any combination of...Level:** Non-Management Non-Exempt **Workshift:** **Job Family:** MED > Licensed Nurse Please be advised that Elevance Health only accepts… more
- Elevance Health (Latham, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... **Anticipated End Date:** 2024-10-04 **Position Title:** Utilization Management Representative I **Job Description:** **Title: Utilization Management… more
- Humana (Albany, NY)
- …through excellent written and verbal communication **Preferred Qualifications** + Registered Nurse + Experience in Medicare Utilization Management + Project ... are addressed. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality audits,… more
- Albany Medical Center (Albany, NY)
- …a changing environment. + Basic knowledge of computer systems with skills applicable to utilization review process. Thank you for your interest in Albany Medical ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more
- Humana (Albany, NY)
- …reports in Access and/or SQL + Graduate degree + Utilization Management Review Experience + Registered Nurse (RN) Credentials + Home Health, Durable Medical ... Equipment, and/or Skilled Nursing Facility Experience **Additional Information** **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the… more
- Elevance Health (Latham, NY)
- …Knowledge of health insurance/benefits, medical management process, care management, and utilization review management strongly preferred. For candidates working ... **Anticipated End Date:** 2024-09-13 **Position Title:** Telephonic Nurse Case Manager II **Job Description:** **Telephonic Nurse Case Manager II** **Location:… more
- Northern Rivers Family Services (Schenectady, NY)
- …cooperate with the County and participate in any quality audit and utilization review + Provide on-site/community based/home visits medication evaluations and ... Nurse -Psychiatric NP Job Details Job Location Schenectady-Park Place...and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate… more
- YesCare Corp (Coxsackie, NY)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Provides appropriate ... Below is a list of your responsibilities as a ** Nurse Practitioner or Physician Assistant** withYesCare at the Coxsackie...in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as… more
- St. Mary's Healthcare (Amsterdam, NY)
- …denials by drafting appeals, negotiating with payers, or following up with payer utilization review departments in attempts of obtaining authorizations and claim ... with medical staff and care coordination leaders to ensure ongoing compliance with utilization review guidelines. * Collaborates with managed care department to… more
- Elevance Health (Latham, NY)
- **Anticipated End Date:** 2024-08-28 **Position Title:** Nurse Medical Management Sr **Job Description:** **Location** : This is a virtual position. Candidates must ... payment. May also manage appeals for services denied ,** **continued stay review , care coordination, and discharge planning for appropriateness of treatment setting… more
- Trinity Health (Troy, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Manager - Vascular Surgery Offices - Capital Region - FT** If you are looking for a ... program, generous tuition allowance and career development **What you will do:** The Nurse Manager of Clinical Care is directly responsible for the daily supervision… more
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly...transition of care with Social Worker + Serves as nurse consultant for Social Worker cases with Clinical or… more
- Albany Medical Center (Albany, NY)
- …scheduling patients for both in person and telehealth visits * Participate in nurse visits including medication review , education and follow-up; patient and ... parent education * Facilitates the utilization of resources to meet patient outcomes and contribute...for both in person and telehealth visits* Participate in nurse visits including medication review , education and… more
- Ellis Medicine (Schenectady, NY)
- …for the comprehensive integration of Discharge Planning, Performance Improvement and Utilization Review activities at patient, hospital, and system levels. ... as a RN in New York State. Experience: Previous Utilization Review , Quality Assessment, Discharge Planning or...the systems in which we work. * Serves as nurse consultant for Social Worker cases with Clinical or… 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...State requirements. + Current state license as a Registered Nurse . + 2 years of Home Health experience with… more
- Elevance Health (Latham, NY)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... claims review , post payment auditing, and provider record review...goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via… more