- Centene Corporation (New York, NY)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical review to ... nurse (RN) required. + Two (2) years of clinical experience as an RN in a varied ...documentation of clinical information for medical necessity review of all requests, procedures, admissions, and concurrent… more
- Northwell Health (Melville, NY)
- …care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective utilization ... management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness of admission and… more
- Glens Falls Hospital (Glens Falls, NY)
- …can be foundhere. **Job:** **Nursing - Case Management* **Title:** *RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** *2410V* ... setting. *How You Will Fulfill Your Potential* *Responsibilities* * Conducts concurrent and retrospective review (s) utilizing InterQual (IQ) medical necessity… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. * Provides clinical information requested by the ... plan of care and coordination of services based on clinical needs and available resources. 3. Utilization Review...monitoring of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process… more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
- Northwell Health (Huntington, NY)
- …Patients Discharge Instruction Sheet and the Patient Transfer Sheet. + Ensures Patient Review Instrument (PRI) is completed and reflects clinical profile of the ... clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred. + Keeps abreast of… more
- Trinity Health (Syracuse, NY)
- …Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and retrospective ... achieved, and high-quality professional practice is realized. **Position Purpose:** Registered Nurse Coordinator is a dynamic leadership role that contributes to the… more
- Northwell Health (Lake Success, NY)
- … clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification ... of clinical documentation from the physician(s) on a ...date. *Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Crouse Hospital (Syracuse, NY)
- …maintaining the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent and continued stay ... Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage data and client...pharmacy, and certain retailers. + YMCA Subsidy program. + Clinical Nursing Pathway Program for Registered Nurses designed to… more
- Northwell Health (Staten Island, NY)
- **Req Number** 144355 Registered Nurse Case Manager - FlexStaff Serves as liaison between the patient and facility/physician. Ensures a continuum of quality patient ... Responsibilities: + Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria… more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
- Nuvance Health (Poughkeepsie, NY)
- …3M data. Attends and participates in educational conferences. Participates in concurrent performance improvement activities and on-going MR review activities. ... a proactive, creative manner using sound judgment based on factual information and clinical knowledge. Education Skills Experience: 1. Registered Nurse (RN) with… more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
- VNS Health (Manhattan, NY)
- OverviewLeads interdepartmental quality improvement activities such as development and engagement, clinical review , clinical risk management, and patient ... Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient care review , including the design, testing… more
- Catholic Health Services (Roslyn, NY)
- Overview REGISTERED NURSE CLINICAL DATA COORDINATOR St. Francis Hospital & Heart Center(R) is New York State's only specialty designated cardiac center. A member ... procedures and guides as appropriate to their role. Performs appropriate targeted concurrent review to improve accuracy and compliance if indicated. Performs… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Mount Sinai Health System (New York, NY)
- …information requested by the managed care companies as part of the concurrent review in a timely fashion. 3. Provides clinical information requested by the ... for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission).… more
- Guthrie (Corning, NY)
- …two (2) years of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who holds a bachelor's degree in a ... to the case management process. Certified to complete Patient Review Instruments (PRIs). Has a working knowledge of the...in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to… more
- Guthrie (Cortland, NY)
- …within two (2) years of hire. Individual consideration may be given to a registered nurse with significant clinical experience who holds a bachelor's degree in a ... Position Summary: This is an integrated Case Management and Utilization Review position. The Acute Care Case Manager utilizes industry accepted processes for… more