• UM RN

    Centers Plan for Healthy Living (Jamaica, NY)
    UM RN 90-27 Sutphin Blvd, Jamaica, NY 11435, USA Req #12129 Monday, December 2, 2024 Centers Plan for Healthy Living's goal is to create the ultimate healthcare ... and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who… more
    Centers Plan for Healthy Living (12/03/24)
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  • COE UM Program Director

    Molina Healthcare (New York, NY)
    …improvement experience **Preferred License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) license in good standing. + ... Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification To all current Molina employees: If you are interested in applying for this position, please apply through the… more
    Molina Healthcare (01/21/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (New York, NY)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. To all… more
    Molina Healthcare (01/21/25)
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  • COE CM Director, ( RN required)

    Molina Healthcare (New York, NY)
    …improvement experience **Preferred License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) license in good standing. + ... _This position requires an actively licensed Registered Nurse_ **JOB DESCRIPTION** **Job Summary** The mission...+ Collaborate with other COE leaders across the enterprise UM , LTSS, BH, Quality, Office of the CMO, Network,… more
    Molina Healthcare (01/21/25)
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  • Care Review Clinician, Inpatient Review…

    Molina Healthcare (New York, NY)
    …acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must ... Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
    Molina Healthcare (01/23/25)
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  • Appeals Manager, Department of Utilization Case…

    BronxCare Health System (Bronx, NY)
    …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... purpose of reporting and implementing corrective measures. - Provide feedback to UM staff related to denial prevention strategies. - Participates in JCAHO hospital… more
    BronxCare Health System (12/18/24)
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  • Case Managment /Care Coordination Director

    Nuvance Health (Norwalk, CT)
    …but not required. MSW considered* *Minimum Experience: five years* Desired: Registered Nurse with management experience. Knowledge of community resources, ... utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. Develops and monitors… more
    Nuvance Health (12/11/24)
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  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …party contractual changes from the Managed Care Department and applies to UM and appeals management processes. | Works collaboratively with physicians, physician ... | Graduate of an accredited Nursing School or College; current New York State, RN License required, BSN Bachelor of Science in Nursing or Health preferred. | Minimum… more
    Catholic Health Services (12/19/24)
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