- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... acute care experience is required as a Licensed Practical Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Trinity Health (Albany, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse , physicians, staff and ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified… more
- Elevance Health (Latham, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... Job Description **Title: Utilization Management Representative I** **Location:** This position will...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- Elevance Health (Latham, NY)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... **Title: Utilization Management Representative II** **Location:** This position will...Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …education, orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities, and ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Dialysis Registered Nurse (RN) is a professional nurse with...education, orientation, competencies and providing quality improvement and outcomes utilization . Practice includes directing other providers. Partners with the… more
- Elevance Health (Latham, NY)
- …Knowledge of health insurance/benefits, medical management process, care management, and utilization review management is strongly preferred. + Clinical ... ** Nurse Case Manager I - NICU** **Location:** **This...claims, or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- YesCare Corp (Coxsackie, NY)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Provides appropriate ... Below is a list of your responsibilities as a ** Nurse Practitioner (NP/ARNP)** withYesCare: + **For this New York...in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as… more
- Elevance Health (Latham, NY)
- …Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. + Partners ... information presented meets medical necessity criteria or requires additional medical necessity review . + Conducts initial medical necessity review of exception… more
- Evolent (Albany, NY)
- …be the single point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work can be divided into ... for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for utilization … more
- Albany Medical Center (Albany, NY)
- …Responds to changes in work efficiently and effectively. Support implementation and utilization of clinical nursing research. Promote the use by colleges and ... procedures, while engaging in and advocating for succession planning for nurse leaders. Establishes standards for all department personnel by having criteria-based… more
- Trinity Health (Albany, NY)
- …Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals of patients at St. Peter's Hospital referred for subacute ... members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources. + Screening of clients… more
- CDPHP (Albany, NY)
- …(3) years of clinical experience required. + Minimum one (1) year of quality/ utilization review experience required. + Experience with research, data retrieval, ... clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations about appropriateness of care,… more
- United Therapeutics (Albany, NY)
- …reimbursement support, patient support programs, field reimbursement managers, patient navigators and nurse educators + Review Needs Assessment Forms related to ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- Albany Medical Center (Albany, NY)
- …Salary Range: $60,028.00 - $99,023.00 Salary range: $68,640 - $99,023 Registered Nurse Endocrinology & Podiatry Office Albany, NY Work Shift: Monday - Friday ... advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN),...or APP and documents results in EHR + Performs review and triage of incoming test results, patient requests… more
- Albany Medical Center (Albany, NY)
- …Salary Range: $60,028.00 - $99,023.00 Salary range: $68,640 - $99,023 Registered Nurse - Full Time Neurosurgery Outpatient Office Work schedule: Monday - Friday ... advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN),...or APP and documents results in EHR + Performs review and triage of incoming test results, patient requests… more
- CDPHP (Albany, NY)
- …you to be a part of that experience. The Medicaid Special Programs Registered Nurse Case Manager is responsible and accountable for coordinating the care of CDPHP ... clinical and cost outcomes. In addition, the Medicaid Special Programs Registered Nurse Case Manager is responsible and accountable for coordinating requests for… more
- United Therapeutics (Albany, NY)
- …with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was ... and collaborate with high level site staff with minimal supervision/escalation needed + Review the quality and integrity of clinical data via Source Document … more
- New York State Civil Service (Claverack, NY)
- …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... health and substance use screens, youth and collateral interviews, and record review to develop a psychosocial assessment and subsequent mental health treatment… more
- OrthoNY (Albany, NY)
- …care. + Responsible for management of Physician block/surgery time; evaluates block utilization and makes recommendations for changes to increase the efficiency of ... the operation of the ASC. + Responsible for ongoing review and revision of policies and procedures; keeps staff...guidance and support to the OR and Pre-op/PACU Charge Nurse to assist them in performing their duties and… more