- Centene Corporation (New York, NY)
- …clinical license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Per Diem Advanced Practice Nurse (APN) for Utilzation Review utilizes a patient-centered coordinated care model, demonstrating competencies in leadership, ... nursing program. 2. Master's or Doctorate degree from an accredited Nurse Practitioner program. 3. Maintains clinical competencies through continuing education and… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title - Nurse Practitioner-Pediatric Cardiology - Mount Sinai Hospital - Full Time - Day** A nurse practitioner (NP) as described in ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (Long Island City, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Veterans Affairs, Veterans Health Administration (Kings County, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Independently provides patient-centered and recovery-oriented care and… more
- Elevance Health (Morristown, NJ)
- ** Nurse Reviewer I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... time,** **with rotating weekends.** **New Grads are encouraged to apply!** The ** Nurse Reviewer I** will be responsible for conducting preauthorization, out of… more
- Atlantic Health System (Morristown, NJ)
- Atlantic Visiting Nurse , part of Atlantic Health System, is seeking a full-time GIP hospice Registered Nurse to work 12PM to 730PM in the Morris, Essex, Union, ... Develops the plan of care for the patient and family Ensures appropriate utilization of services + Maintains visit productivity standards + Demonstrates knowledge of… more
- Project Renewal, Inc. (New York, NY)
- …in the development and implementation of quality assurance management and utilization review + Participates in interdisciplinary meetings with shelter ... Title: Primary Care Nurse Practitioner - Part Time Program: Healthcare Department...$87,000 depending on experience Position Overview: The Primary Care Nurse Practitioner working in Mobile Health is responsible for… more
- Chatham Hills Subacute Care Center (Chatham, NJ)
- …meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training ... a week 37.5 - 40 hours per week Respiratory Nurse (RN) We are searching for a highly motivated,...communications within the facility with the director of nursing, nurse managers, and admissions coordinator to assist in development… more
- Elevance Health (Woodbridge, NJ)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- WellLife Network (South Richmond Hill, NY)
- …location and schedules are subject to change. 5. Attend certification inspections, utilization review and independent professional reviews as needed. 6. Attend ... medical pre-admission evaluations and screening of prospective clients. 2. Review and update persons with disabilities pre-admission evaluation within thirty… more
- Hackensack Meridian Health (Edison, NJ)
- …New Jersey program and its Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review procedures. + Knowledge of ... EPIC. **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP Certification. **Licenses… more
- Northwell Health (Sleepy Hollow, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + Submits ... patient in collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of stay; Facilitates throughput.… more
- Fresenius Medical Center (Teaneck, NJ)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- Fresenius Medical Center (Union, NJ)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Yonkers, NY)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Yonkers, NY)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more