- Humana (Albany, NY)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN) supports daily coordination of care across healthcare continuum with the healthcare team, ... preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN ensures...field required. Current registration as a Licensed Registered Professional Nurse in New York State. Two (2) to three… more
- Elevance Health (Latham, NY)
- **Title: Utilization Management Representative II** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative II** will be responsible...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles… more
- Elevance Health (Latham, NY)
- Job Description **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates ... 50 miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… 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
- 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 Dialysis Registered Nurse (RN) is a professional nurse with...education, orientation, competencies and providing quality improvement and outcomes utilization . Practice includes directing other providers. Partners with the… more
- Elevance Health (Latham, NY)
- ** Nurse Case Manager I - NICU** **Location:** **This... management process, care management , and utilization review management is strongly ... start earlier than 8 am EST.** The **Telephonic NICU Nurse Case Manager I** is responsible for the NICU...claims, or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Latham, NY)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… 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 is a...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… 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 ... experience in a hospital environment preferred. + Previous case management , utilization review , and discharge...transition of care with Social Worker + Serves as nurse consultant for Social Worker cases with Clinical or… more
- Evolent (Albany, NY)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… 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...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more
- Highmark Health (Albany, NY)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
- Evolent (Albany, NY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Albany Medical Center (Albany, NY)
- …of short and long-term goals and objectives. As a member of the nursing management team, the AVP of Nursing participates in the efficient and effective management ... ensure compliance with all regulatory standards. Planning and Program Management Provides administrative direction and coordination in the formulation,… more
- Intermountain Health (Albany, NY)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more
- CDPHP (Albany, NY)
- …with Medicaid Long Term Care Programs preferred. + Minimum of two (2) years Utilization Management experience is preferred. + Experience with the New York State ... Programs RN Case Manager and the success of the member-focused Complex Case Management Programs. Qualifications: + Registered Nurse with a current New York… more
- United Therapeutics (Albany, NY)
- …with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was ... on behalf of UTC + Attain a thorough understanding of site management tasks and responsibilities necessary to implement compliance with the protocol, applicable… more
- OrthoNY (Albany, NY)
- …and is accountable for the quality of nursing care. + Responsible for management of Physician block/surgery time; evaluates block utilization and makes ... is responsible for strategic planning, budgeting, regulatory compliance, and performance management , ensuring the highest standards of patient care and operational… more
- GE Vernova (Schenectady, NY)
- …clients a wide range of solutions across power generation, delivery and utilization . **Essential Responsibilities** + Mentor team of engineers in support of GE ... CS verticals (eg SW team) to ensure sharing and improvement of tools. + Review technical reports for team prior to submittal to customers. + Develop, advertise and… more