• UM RN

    Centers Plan for Healthy Living (Jamaica, NY)
    UM RN 90-27 Sutphin Blvd, Jamaica, NY 11435, USA Req #12129 Monday, December 2, 2024 Centers Plan for Healthy Living's goal is to create the ultimate healthcare ... and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who… more
    Centers Plan for Healthy Living (12/03/24)
    - Save Job - Related Jobs - Block Source
  • COE UM Program Director

    Molina Healthcare (New York, NY)
    …improvement experience **Preferred License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) license in good standing. + ... Utilization Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification To all current Molina employees: If you are interested in applying for this position, please apply through the… more
    Molina Healthcare (01/13/25)
    - Save Job - Related Jobs - Block Source
  • Transition of Care Registered Nurse

    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...+ Knowledge of Milliman criteria (MCG) preferred + For UM Only: Experience must be with a Managed Care… more
    VNS Health (01/02/25)
    - Save Job - Related Jobs - Block Source
  • Lead, Auditor ( RN ) Appeals & Grievances…

    Molina Healthcare (New York, NY)
    …to resolve/correct them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ) Program and an Associate's or ... nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), Member Assessment Team (MAT), Health...+ Required License, Certification, Association + Active, unrestricted State Registered Nurse ( RN ) License in… more
    Molina Healthcare (01/13/25)
    - Save Job - Related Jobs - Block Source
  • Care Review Clinician, Prior Auth ( RN )

    Molina Healthcare (New York, NY)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Preferred… more
    Molina Healthcare (01/13/25)
    - Save Job - Related Jobs - Block Source
  • COE CM Director, ( RN required)

    Molina Healthcare (New York, NY)
    …improvement experience **Preferred License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) license in good standing. + ... _This position requires an actively licensed Registered Nurse_ **JOB DESCRIPTION** **Job Summary** The mission...+ Collaborate with other COE leaders across the enterprise UM , LTSS, BH, Quality, Office of the CMO, Network,… more
    Molina Healthcare (01/13/25)
    - Save Job - Related Jobs - Block Source
  • Clinical Design Director ( RN required)

    Molina Healthcare (New York, NY)
    …improvement experience **Preferred License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) license in good standing. + ... _Candidates must possess a current RN license, as well as a Bachelor's Degree_...+ Collaborate with other COE leaders across the enterprise UM , LTSS, BH, Quality, Office of the CMO, Network,… more
    Molina Healthcare (01/13/25)
    - Save Job - Related Jobs - Block Source
  • Care Review Clinician, Inpatient Review…

    Molina Healthcare (New York, NY)
    …care/medical experience. R **equired License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must have ... Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
    Molina Healthcare (01/13/25)
    - Save Job - Related Jobs - Block Source
  • Care Review Clinician, Inpatient Review…

    Molina Healthcare (New York, NY)
    …acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must ... Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
    Molina Healthcare (01/10/25)
    - Save Job - Related Jobs - Block Source
  • Clinical Evalution Manager, RN - mostly…

    VNS Health (Manhattan, NY)
    …as assigned. Qualifications Licenses and Certifications:Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York ... State requiredCertified Case Manager preferredFor SelectHealth ETE Only: Nurse Practitioner (NP) certification with background or degree in Public Health… more
    VNS Health (01/03/25)
    - Save Job - Related Jobs - Block Source
  • Case Managment /Care Coordination Director

    Nuvance Health (Norwalk, CT)
    …provider of cardiology care. Non-acute care is offered through various affiliates, * Registered Nurse or Masters Social Work with management experience* *$30K ... desired but not required. MSW considered Minimum Experience: five years Desired: Registered Nurse with management experience . Knowledge of community resources,… more
    Nuvance Health (12/11/24)
    - Save Job - Related Jobs - Block Source
  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …party contractual changes from the Managed Care Department and applies to UM and appeals management processes. | Works collaboratively with physicians, physician ... | Graduate of an accredited Nursing School or College; current New York State, RN License required, BSN Bachelor of Science in Nursing or Health preferred. | Minimum… more
    Catholic Health Services (12/19/24)
    - Save Job - Related Jobs - Block Source