- Independent Health (Buffalo, NY)
- …enjoying first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical review ... clinical experience as an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care… more
- Independent Health (Buffalo, NY)
- …well as manage medical expenses based on trends. They will maintain UM review requirements, obtain reporting to understand utilization trends and cost, recommend ... and commitment to diversity and inclusion. **Overview** The Program Manager- Utilization Management (UM) will be accountable for the management, implementation,… more
- Catholic Health (Kenmore, NY)
- …(2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or ... Holiday Rotation Hours: 0800-1600, 0900-1700, 1000-1800 Summary: The Registered Nurse (RN) Care Manager-Transition of Care, as an active...Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New… more
- Catholic Health (Buffalo, NY)
- …Two (2) years acute care RN experience required + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or Disease ... Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New...Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New… more
- Molina Healthcare (Buffalo, NY)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Independent Health (Buffalo, NY)
- …day-to-day management of the RN staff of their assigned area (Case Management, Utilization Review and Population Health). This will include monitoring the daily ... a current and accurate database. + Provide high quality, professional utilization management services: (medical necessity review for Prior Authorization,… more
- Kaleida Health (Buffalo, NY)
- …2 years of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interqual Criteria set ... with members of the interdisciplinary team to coordinate care, facilitate utilization and resource management and discharge planning functions, working to achieve… more
- Molina Healthcare (Buffalo, NY)
- …staffing and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case ... be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals and Grievances experience and a clinical background. The… more
- Kaleida Health (Williamsville, NY)
- …plans/care paths are addressed and met. Serve as liaison to ancillary and utilization review services, serve as communication link between health team members. ... Bachelors degree in Nursing. Current NYS Registration as a Professional Nurse . Certified Case Manager (CCM) preferred. **Experience** **Other information:** At least… more
- Kaleida Health (Buffalo, NY)
- …applies to Acute Care setting preferred) **Job Details** Department: HPTE SNF Utilization Review Standard Hours Per Week: 75.00 Weekend/Holiday Requirement: No ... School Diploma or GED required. BS - Bachelor of Science nursing preferred. Registered Nurse required upon hire. FIM Function Indp Meas required within 90 days. FIM… more
- Molina Healthcare (Buffalo, NY)
- …and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes new ... unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality… more