- 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
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... recognized criteria and CDPHP policies, and procedures. QUALIFICATIONS: + Registered Nurse or Licensed Practical Nurse... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge… 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
- Elevance Health (Latham, NY)
- ** Nurse Case Manager I - NICU** **Location:** **This... management process, care management , and utilization review management is strongly ... start earlier than 8 am EST.** The **Telephonic NICU Nurse Case Manager I** is responsible for the NICU...claims, or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Trinity Health (Albany, NY)
- …other related duties as assigned Experience and Requirements + Active Licensure as a registered nurse , preferably with a **bachelor's degree** in nursing from an ... Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals...accredited school and Certified Registered Rehab Nurse preferred (CRRN). + A… 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
- 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
- CDPHP (Albany, NY)
- …NYS external review , and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with valid ... (3) years of clinical experience required. + Minimum one (1) year of quality/ utilization review experience required. + Experience with research, data retrieval,… more
- Elevance Health (Latham, NY)
- …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... The **Medical Management Clinician Associate** is responsible for ensuring appropriate,...RN license and/or certification to practice as a health… more
- Elevance Health (Latham, NY)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... required. **Preferred Skills, Capabilities, and Experiences** **:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… 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
- Sharecare (Albany, NY)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... members of the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager. All Sharecare clinicians… more
- Cardinal Health (Albany, NY)
- …and service education to facilitate technology adoption and workflow change management . + Demonstrates extensive knowledge and understanding of relevant clinical ... best demonstrated practices + Significantly influences customer acceptance and utilization of new products and services in multi-site and/or...of the time + Bachelor's degree preferred + Current RN license preferred + 6-8 years of experience in… more