- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Baylor Scott & White Health (Albany, NY)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
- Independent Health (Buffalo, NY)
- …enjoying first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical review ... Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. + Two (2) years of… more
- Glens Falls Hospital (Glens Falls, NY)
- …**Job:** **Nursing - Case Management * **Title:** * RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** *2410V* ... utilization management , or payer experience preferred. *Licenses/Certifications/Registrations* * ** Registered Nurse ( RN ) in New York State* *… more
- Northwell Health (Huntington, NY)
- …care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness ... license to practice as a Registered Professional Nurse in New York State. + Case Management... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more
- Guthrie (Cortland, NY)
- Position Summary: This is an integrated Case Management and Utilization Review position. The Acute Care Case Manager utilizes industry accepted processes for ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...experience in an acute care setting with strong case management , utilization review and payer… more
- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... (typically requires 6 weekends a year). Utilization Management Registered Nurse ( RN...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… 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,… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent ... outcomes are achieved, and high-quality professional practice is realized. **Position Purpose:** Registered Nurse Coordinator is a dynamic leadership role that… more
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - Case Management - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of Case ... regulatory compliance. Education/Experience Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work… more
- Guthrie (Binghamton, NY)
- …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant...members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria.… 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
- Molina Healthcare (NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **WORK SCHEDULE: Mon - Fri / Sun… more
- Fresenius Medical Center (Camillus, NY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Catholic Health (Buffalo, NY)
- …(2) years acute care RN experience required + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or Disease ... and families in the hospital setting. Utilizing foundational case management and discharge planning principles, the RN ...BS Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York… more
- Catholic Health (Kenmore, NY)
- …Days with Weekend and Holiday Rotation Hours: 0800-1600, 0900-1700, 1000-1800 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 (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
- Crouse Hospital (Syracuse, NY)
- …establish the plan of care. Care Manager Position Requirements: + Must have a current Registered Nurse ( RN ) license. + Graduate from an accredited nursing ... Coordination Services team is hiring a Care Manager to review the services delivered to patients and compare to...maintaining the quality of care. + Participates in the utilization management process using standards of care… more
- Calvary Hospital (Bronx, NY)
- …which is responsible for the coordination of the hospital-wide functions of Case Management , Utilization Review and Discharge Planning. Oversees and ... regarding the above functions. Qualifications: + Current NYS unencumbered Registered Nurse license. + Case Management...Minimum of five (5) years of experience in Case Management , Utilization Review or Discharge… 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 ... + Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria +… more