- Molina Healthcare (Manhattan, NY)
- …people who are eligible for Medicaid and Medicare.** **We are looking for Registered Nurse Care Review Clinicians with Prior Authorization experience. ... programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies...Education** Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse… more
- Trinity Health (Syracuse, NY)
- …outcomes are achieved, and high-quality professional practice is realized. **Position Purpose:** Registered Nurse Coordinator is a dynamic leadership role that ... Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and retrospective inpatient and… more
- Independent Health (Buffalo, NY)
- … care operations required; multi-dimension project management experience preferred. + Registered Nurse (RN) with active, unrestricted NYS license strongly ... to diversity and inclusion. **Overview** The Program Manager-Utilization Management ( UM ) will be accountable for the management, implementation, communication, and… more
- Crouse Hospital (Syracuse, NY)
- Care Coordination is a collaborative practice model including...CERTIFICATION / LICENSURE + Required: + Licensed as a Registered Nurse in New York State. + ... the multidisciplinary health care team, the patient and family, and community services...strategies for compliance. The Manager works closely with the UM and Appeals and Denials staff as both areas… more
- Molina Healthcare (New York, NY)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional… more
- Highmark Health (Albany, NY)
- …+ Licensed Marriage and Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + Working knowledge of ... Certification in utilization management or a related field + Experience in UM /CM/QA/Managed Care **LICENSES AND CERTIFICATIONS** **Required** (any of the… more
- 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 ... and develop strong appeals for the purpose of securing reimbursement for acute care services provided to patients. Assist in development of strategies for denial… more
- Ellis Medicine (Schenectady, NY)
- …and assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, ... primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse ...Meets with patient, family and/or designee to ensure post-acute care referrals are executed to various community partners, financial… more
- VNS Health (Manhattan, NY)
- …assigned. Qualifications Licenses and Certifications: + Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York ... Certified Case Manager preferred + For SelectHealth ETE Only: Nurse Practitioner (NP) certification with background or degree in...UM Only: Experience must be with a Managed Care Organization or Health Plan. + For SelectHealth ETE… more
- Mohawk Valley Health System (Utica, NY)
- …+ BSN Licensure/Certification Requirements REQUIRED: + NYS License as a Registered Nurse . Disclaimer Qualified applicants will receive consideration for ... those that were admitted during hours without an access nurse on duty. + Ensure the appropriate level of...in Hospital Case Management. + Knowledge and experience with Care Guidelines, Medical Necessity Criteria and/or other UM… more
- Molina Healthcare (Buffalo, NY)
- _This position requires an actively licensed Registered Nurse_ **JOB DESCRIPTION** **Job Summary** The mission of Clinical Operations is to drive value through an ... model concept design. + Collaborate with other COE leaders across the enterprise UM , LTSS, BH, Quality, Office of the CMO, Network, Government Contracts, Growth and… more