- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and...and Certifications: + Current license to practice as a Registered Professional Nurse or an Occupational Therapist… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …important contribution that each team member makes to the patient's well-being. Responsibilities The Registered Nurse ( RN ) is assigned to the Operating Room ... Summary The Western New York VA Medical Center is hiring for one, full-time Registered Nurse to work in the Operating Room (OR). The perioperative OR … more
- Sharecare (Albany, NY)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...the disease management program intervention guidelines. An RN is supervised by an Operations Manager (OM). All… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …of the EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Dialysis Registered Nurse ( RN ) is a professional nurse with ... BSN 3-5 Years Med/Surg or Critical Care experience At least 1 year of registered nurse dialysis experience Caring for acute, chronic and peritoneal dialysis… more
- Veterans Affairs, Veterans Health Administration (Syracuse, NY)
- …for consideration as vacancies are available. The Nurse Inpatient Staff Registered Nurse ( RN ) is responsible for providing competent, evidence-based ... orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Crouse Hospital (Syracuse, NY)
- …within a fast growing Medical Practice + Longevity and consistency of management + Perfect attendance award + Tuition reimbursement program + Employee referral ... annually, and a 401k with 4% employer match Position Description: The RN Care Coordinator will coordinate all systems/services required for an organized,… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... entry date. + Current License to practice as a Registered Professional Nurse in New York State...specialized certifications as needed. + Prior experience in Case Management , Utilization Review, and Appeals/Denials, highly preferred.… more
- CVS Health (Albany, NY)
- …convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in ... any state. As a Utilization Management Nurse Consultant, you...**Required Qualifications** - Must have active current and unrestricted RN licensure in state of residence - 3+ years… more
- Highmark Health (Albany, NY)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- VNS Health (Manhattan, NY)
- …in development of plans to address improvement needs as appropriate.* For Utilization Management Only:* Issues Determinations, Notices of Action, and other ... communications required by state or federal regulations are saved in the Utilization Management System.* Reviews, evaluates and determines the appropriateness of… more
- Elevance Health (NY)
- …following standard procedures that do not require the training or skill of a registered nurse . **How You Will Make an Impact** Primary duties may includes, ... **Medical Management Clinician Associate ( RN )** **Location:** Elevance...sites used for collaboration, community, and connection. This includes remote work and 1-2 days in-office per week at… more
- Elevance Health (Latham, NY)
- …Service Coordinator - RN Telehealth** _Location:_ While this position is fully remote , candidate must reside in the tri-state area (NY, NJ, or CT) and within ... 50 miles of a PulsePoint. The **LTSS Service Coordinator - RN Telehealth** is responsible for overall management of member's case within the scope of licensure;… more
- Guardian Life (Albany, NY)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Highmark Health (Albany, NY)
- … - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +...and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** +… more
- VNS Health (Manhattan, NY)
- …years' experience in a Grievance and Appeals or related area such as medical or utilization management in a Managed Care setting required + Experience in a ... Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of our grievance and...+ License and current registration to practice as a registered professional nurse in New York State… more
- Molina Healthcare (NY)
- … Registered Nursing ( RN ) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), ... direction and oversight to the segment clinical teams - specifically care management and utilization management - designed to achieve best in class… more
- Centene Corporation (New York, NY)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure required Pay Range: ... and actions taken on member medical records in health management systems according to utilization management...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… 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
- SUNY Upstate Medical University (Syracuse, NY)
- …field) and a minimum of three years RN post-licensure nursing experience or RN Utilization Management , or Associate's Degree in Nursing and five years ... Job Summary: The Utilization Review/Quality Assurance Sr. Coordinator will be responsible...federal regulations and all CMS activities. Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelors Degree in… more