• UM Registered Nurse

    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
    Molina Healthcare (12/14/24)
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  • Care Review Clinician, PA (RN)

    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
    Molina Healthcare (12/20/24)
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  • Appeals Manager, Department of Utilization Case…

    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
    BronxCare Health System (12/18/24)
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  • Clinical Evaluation Manager

    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
    VNS Health (12/14/24)
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