- Independent Health (Buffalo, NY)
- …enjoying first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical review ... clinical experience as an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care… more
- Glens Falls Hospital (Glens Falls, NY)
- …week, can be foundhere. **Job:** **Nursing - Case Management* **Title:** *RN - Utilization Review Nurse * **Location:** *NY-Glens Falls* **Requisition ID:** ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing… more
- Trinity Health (Syracuse, NY)
- …12-day shifts. Emergency department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review (UR), Clinical Care Manger ... (CCM) actively manages the utilization review process and patient progression from...to all patients in accordance with the New York Nurse Practice Act, National Standards of Practice, and Nursing… more
- Crouse Hospital (Syracuse, NY)
- …while maintaining the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent and continued stay ... outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage data and client care as… more
- CVS Health (Albany, NY)
- …9pm EST depending on business needs **Preferred Qualifications** - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... to make health care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the… more
- VNS Health (Manhattan, NY)
- …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... CEU credits, and advancement opportunities What You Will Do + Conducts comprehensive review of all components related to requests for services which includes a… more
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and ... retrospective inpatient and outpatient services, in accordance with the utilization requirements and 3rd party payor contracts. The UM department is responsible for… more
- New York State Civil Service (Malone, NY)
- …of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning.Substitution: a bachelor's degree in nursing ... Yes Agency Corrections and Community Supervision, Department of Title Registered Nurse 3 - Utilization Per Diem - NY HELPS Occupational Category Health Care,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Baylor Scott & White Health (Albany, NY)
- …vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee care coordination across ... Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. +...experience + Hold a valid registration as a Registered Nurse As a health care system committed to improving… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Review Admission Specialist (OR Scheduler), Operating Room Surgical Scheduling, Mount Sinai West - Full Time, Days** The ... Utilization Review Specialist coordinates scheduling of all...and operating room procedures. Seeks the assistance of the Nurse Manager in identifying cases, which require pre admission… more
- VNS Health (Manhattan, NY)
- …CEU credits, and advancement opportunities What You Will Do + Reviews specific utilization issues or requests with Clinical Review team, focusing on problem ... Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with...and current registration to practice as a registered professional nurse in New York State Required + Valid driver's… more
- Independent Health (Buffalo, NY)
- …well as manage medical expenses based on trends. They will maintain UM review requirements, obtain reporting to understand utilization trends and cost, recommend ... and commitment to diversity and inclusion. **Overview** The Program Manager- Utilization Management (UM) will be accountable for the management, implementation,… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN) supports daily coordination of care across healthcare continuum with the healthcare team, ... responsible for preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN ensures the appropriate level of… more
- WMCHealth (Valhalla, NY)
- …implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical ... York State Department of Education, as a registered professional nurse . Training and Experience: three years of experience where...of which must have been in the area of utilization review , quality assurance, risk management or… more
- Elevance Health (NY)
- …incoming calls or incoming requests for services work. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and ... **Clerk - Utilization Management Representative I** **Location:** Elevance Health supports...responsible for coordinating cases for precertification and prior authorization review . **How You Will Make an Impact** Primary duties… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- BronxCare Health System (Bronx, NY)
- …prepare a response for submission in appeal. - In absence of Director, will review denial correspondence to determine validity of denial reason and course of action ... and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate with ECFMG… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title: Nurse Practitioner-Outpatient Multiple Myeloma/Oncology - Mount Sinai Hospital - Full Time - Day** A nurse practitioner (NP) as ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion… more