- Centene Corporation (New York, NY)
- …**Must have a New York State license or identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and determination. Completes data entry and correspondence as necessary for each review . + Conducts rate negotiation with non -network providers, utilizing… 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
- Mount Sinai Health System (Manhattan, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Elevance Health (Woodbridge, NJ)
- …and over- utilization by performing medical reviews via prepayment claims review and post-payment auditing. + Correlates review findings with appropriate ... ** Nurse Auditor Senior - Carelon Payment Integrity** **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- City of New York (New York, NY)
- …CAS works with other programs at HRA and with other governmental and non -governmental service providers to create new programs and to integrate and refine existing ... CAS Visiting Psychiatric Services (VPS) Unit is recruiting for two (2) Psychiatric Nurse Practitioner for the roles below. Under the supervision of the Medical… more
- Hackensack Meridian Health (Edison, NJ)
- …duties with attention to detail and in a timely manner. + Collaborates with Utilization Review Nurses. + Referrals: + Primary Care Physicians + Behavioral Health ... degree in nursing (BSN) or 1 year experience for non BSN HackensackUMC employees. + Knowledge of managed care...Quality Metrics. + Knowledge of health care delivery system, utilization and review and case review… more
- Atlantic Health System (Morristown, NJ)
- Atlantic Visiting Nurse , part of Atlantic Health System, is seeking a full-time hospice Registered Nurse to work Monday - Friday from 8 AM to 4 PM in the Morris, ... of care for the patient and family Ensures appropriate utilization of services + Maintains visit productivity standards +...Morristown, New Jersey, we are one of the leading non -profit health care systems in the state, and committed… more
- Atlantic Health System (Morristown, NJ)
- …departments, and the community. Supports socialization, education, and training of novice nurse ethicists by serving as a preceptor, role model, and mentor. ... Participates in performance improvement activities related to the role of a nurse ethicist and the patient population requiring an ethics consult. Assists in… more
- Atlantic Health System (Summit, NJ)
- …management, including product evaluation, prevention of waste and damage, room utilization , control of overtime, and appropriate staffing mix. 7. Facilitates ... as assigned Required: 1. Bachelor's Degree Required 2. Registered Nurse (RN) required 3. Three (3) years' experience in...Morristown, New Jersey, we are one of the leading non -profit health care systems in the nation. Our facilities… more
- Atlantic Health System (Morristown, NJ)
- …and identifies relevant researchable clinical problems with staff. Resource Utilization : Evaluates factors related to safety, effectiveness, availability, and cost ... of the hospital based on autonomy, benefice justice, and non -maleficence in healthcare delivery and the formation of ethical...100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -… more
- Mount Sinai Health System (New York, NY)
- …The Clinical Program Manager, Clinical Command Center is a Registered Professional Nurse , Physician Assistant, or Nurse Practitioner, who manages the 24 ... and supporting patient-centered care. **Qualifications** * Must be a Licensed Registered Nurse , Physician Assistant or Nurse Practitioner Registered Nurse … more
- Mount Sinai Health System (New York, NY)
- …the Nursing Department. The Staffing Office collaborates with Nursing Leadership to review and develop schedules based on agreed upon staffing guidelines, models and ... health care experience + 2+ years related experience, required with Associates degree Non -Bargaining Unit, M71 - Nursing Staff Office - MSH, Mount Sinai Hospital… more
- BAYADA Home Health Care (Morristown, NJ)
- **BAYADA Home Health Care** is currently seeking a full-time **Registered Nurse , RN,** to fill the position of **_Clinical Nurse Manager_** in our office located ... in Morristown, NJ **.** As Nurse Manager you will lead the field staff in...and mentoring of Clinical Associates and field staff + Utilization Management + Developing and mentoring staff to become… more
- VNS Health (Manhattan, NY)
- …others as applicable. * Evaluates branch operations; analyzes trends in volume, utilization , and other business drivers to understand the impact these factors have ... per action plans. * Audits and approves visit and non -visit payroll activities in HCHB; creates payroll batches each...for the visit. * Leads weekly IDT meetings to review /discuss patient status/issues. Determines if patients that are planned… more
- Mount Sinai Health System (New York, NY)
- …to influence other services by focusing on patient processes. 10.Develops and implements Utilization Review (UR) based on internal data collection, data received ... 5 years case management and 6 years as clinical nurse . Previous supervisory experience in case management or related...York State + Certification in case management is preferred Non -Bargaining Unit, BEZ - Utilization Management -… more
- Atlantic Health System (Florham Park, NJ)
- …plan, including transfer eligibility, level of care, resource prioritization & utilization , timely acceptance, and appropriate priority and mode of transport. + ... clinicians involved in patient transfers. + Communicates clinical, and non -clinical, information to relevant parties including nurses, physicians, specialists, and… more
- CenterLight Health System (Ridgewood, NY)
- …ensure appropriate regulatory compliance. + Serves as administrative on call during non -operational hours of the physical sites. + Collaborates with departments to ... that further membership growth. + Responsible for following expenditure and utilization targets. Track Metrics + Hospital admissions/readmissions. + Budgetary. + NH… more
- Mount Sinai Health System (New York, NY)
- …records, internal and external regulatory and survey requirements. The Clinical Nurse Manager collaborates with multiple professionals to support and coordinate the ... & family as well as the organization. The Clinical Nurse Manager is the Nursing Leader of their designated...communication. + Critical thinking and organizational skills are essential. Non -Bargaining Unit, LAI - HSO Pharmacy Home Infusion- STL,… more
- CenterLight Health System (Ridgewood, NY)
- …religious backgrounds, and congenital or acquired disabilities. JOB RESPONSIBILITIES: + Review and ensure effective development and execution of personalized care ... needed. + Serve as a manager on call during non -operational hours of the physical sites and responsible for...Delivery reports. + Participates and represents the Community Health Nurse (CHN) in all IDT meetings, when required. +… more