- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time) Schedule: ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act...Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse -… more
- Catholic Health (Kenmore, NY)
- …Days with Weekend and Holiday Rotation Hours: 8 am- 4 pm Summary: The Registered Nurse ( RN ), Utilization Review , as an active member of the Middle ... in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with...facilitate movement of the patient through the continuum. The Utilization Review RN identifies and… more
- Catholic Health (Buffalo, NY)
- …Care Hospital Setting + Minimum five (5) years of experience working within Utilization Review /Case Management /Clinical Documentation Integrity or + Minimum ... interdisciplinary care team and works in conjunction with the Utilization Review Manager and Manager Clinical Documentation...EDUCATION + Bachelor of Science Nursing (BSN) degree + Registered Nurse with a current New York… more
- Kaleida Health (Buffalo, NY)
- …preferred. RN licensure required.** **Experience** **10 years of care management / utilization management experience required in hospital and/or ambulatory ... **VP Care Management Post-Acute Care Transition** **Location:** **Buffalo General Medical...daily oversight of operations, the VP will partner with Utilization Review , Revenue Cycle, and Clinical leadership… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... holiday every other year. Sign-On Bonus: Yes SUMMARY:As a Registered Nurse - Care Manager, your excellent...+ Three (3) years of acute hospital care, case management or utilization management experience… more
- Molina Healthcare (Rochester, NY)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support... licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review… more
- Molina Healthcare (Rochester, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. MULTI… more
- Rochester Regional Health (Rochester, NY)
- …Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education ... Management Data base to support the clinical review process. + Concurrently monitors resources utilization ,...required + Licensed in New York State as a Registered Nurse + For hires after 10/28/2024,… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... navigation for patients, including triage management , algorithm management , utilization management and resource...possible after admission-within the first12 to 24 hours. Applies utilization review criteria to assess and document… more
- Molina Healthcare (Rochester, 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 ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Catholic Health (Buffalo, NY)
- …and Holiday Rotation Hours: Primary 10-6pm with potential rotation 8-4pm, 9-5pm Summary: The Registered Nurse ( RN ) Care Manager-Transition of Care, as an ... BS Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York...and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of… more
- Veterans Affairs, Veterans Health Administration (Batavia, NY)
- …to apply. Responsibilities The Batavia VA Medical Center is seeking a qualified full-time Registered Nurse ( RN ) to join Long-term care in the Community ... applicants will be considered and referred as vacancies become available. The CLC Registered Nurse is responsible and accountable for all elements of the… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse Case Manager IIDepartment: Home Care Location: West Monroe Hours Per Week: 40Schedule: Days SUMMARY:The RN Case Manager is ... + Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. +… more
- University of Rochester (Rochester, NY)
- …record. Other duties as assigned. **MINIMUM EDUCATION & EXPERIENCE** + Associate's degree Registered Nurse ( RN ) required + Bachelor's degree in Nursing ... Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: UR - Day...HDM, Cobius, and Sharepoint preferred **LICENSES AND CERTIFICATIONS** + RN - Registered Nurse -… 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. ... discharge planning, case management and home care required. Knowledge of Utilization Management . Use of computer applications related to health care industry… more
- Villa of Hope (Rochester, NY)
- …JOB SUMMARY: Under the general direction of the Nurse Manager, the Intake Coordinator- RN is a Registered Nurse who will assist in supervising Clinical ... director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and...or leaving against medical advice. MINIMUM QUALIFICATIONS: + NYS Registered Nurse license + Bachelor degree preferred… more
- University of Rochester (Rochester, NY)
- …- Quality Assurance and Process Improvement (QA/PI) experience preferred LICENSES AND CERTIFICATIONS - RN - Registered Nurse - State Licensure and/or Compact ... primary internal contact for national and state registry data management questions, issues or concerns, but not limited to...State Licensure Current licensure as a Registered Nurse in NYS upon hire required… more
- DePaul (Rochester, NY)
- …Quality Management planning. + Performs all other duties as assigned. Qualifications + Registered Nurse or Licensed Practical Nurse with 3 years of ... Management Plan within the corporation. + Incident Management - review incident reports and provide...reporting and follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual… more
- University of Rochester (Rochester, NY)
- …Technician (RHIT) Program **_or_** + Licensure/credentials in clinical specialty such as Registered Nurse , Licensed Practical Nurse , or Emergency Medical ... requests, and external oversight: ie) NYS DOH, ACS Committee on Trauma Registry Management : + Monitor security of data to ensure the integrity and reliability of… more