- Molina Healthcare (Albany, NY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization...experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Highmark Health (Albany, NY)
- …of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** + ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...outcomes. Will monitor and analyze the delivery of health care services in accordance with claims submitted, and analyzes… more
- Albany Medical Center (Albany, NY)
- …resolve potential problems to ensure the continuity of appropriate patient care . + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... care based on current practices and technological advances. Review current literature and resources to support new practices....ACLS Upon Hire - required + CCRN - Critical Care Registered Nurse (Adult, Neonatal,… more
- Albany Medical Center (Albany, NY)
- …knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact State ... patient outcomes within appropriate LOS and financial constraints. + Provides collaborative care management with the primary nurse in assessing for discharge… more