- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Baylor Scott & White Health (Albany, NY)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- … of the EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Dialysis Registered Nurse ( RN ) is a professional nurse with ... BSN 3-5 Years Med/Surg or Critical Care experience At least 1 year of registered nurse dialysis experience Caring for acute, chronic and peritoneal dialysis… more
- Highmark Health (Albany, NY)
- …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Sharecare (Albany, NY)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… 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
- Albany Medical Center (Albany, NY)
- …in the field of Clinical Social Work or Nursing with experience in Case Management , Utilization Review and Discharge Planning. * BLS Certification. * ... principles of conflict resolution and promote consensus building.* Represents Case Management /Social Work at organizational committee meetings as directed* Serves as… more
- CenterWell (Clifton Park, NY)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...NY State requirements. + Current state license as a Registered Nurse . + 2 years of Home… more
- Guardian Life (Albany, NY)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- CDPHP (Albany, NY)
- …Programs RN Case Manager and the success of the member-focused Complex Case Management Programs. Qualifications: + Registered Nurse with a current New ... a part of that experience. The Medicaid Special Programs Registered Nurse Case Manager is responsible and...Care Programs preferred. + Minimum of two (2) years Utilization Management experience is preferred. + Experience… more
- Evolent (Albany, NY)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- United Therapeutics (Albany, NY)
- …Degree preferably in a health, biological sciences, or related field or + Registered Nurse ( RN ) nursing qualifications or relevant clinical research ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… 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