- 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
- 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
- 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
- New York State Civil Service (Albany, NY)
- …years of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning. Substitution: a bachelor's degree in ... NYC State NY Zip Code 12226 Duties Description Registered Nurse 3 ( Utilization ) conducts medical chart reviews,...various other specific duties related to the primary functions. Review individual cases to ensure care provided is consistent… 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
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly...transition of care with Social Worker + Serves as nurse consultant for Social Worker cases with Clinical or… 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
- CenterWell (Clifton Park, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...State requirements. + Current state license as a Registered Nurse . + 2 years of Home Health experience with… more
- Albany Medical Center (Albany, NY)
- …own team, manages, and maintains staff assignments, hires and performs employee review , trains, and coaches' staff as needed, develops and reports department ... In conjunction with clinical perioperative leadership, identify standardization and utilization opportunities. + Define business requirements for supplies, implants,… 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
- 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