- Independent Health (Buffalo, NY)
- …perks, benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review ... clinical experience as an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care… more
- Molina Healthcare (Buffalo, NY)
- …for the development, implementation, and delivery of training curriculum for Utilization Management, Case Management, and LTSS staff. Leads and manages classes, ... job. Job Qualifications **REQUIRED EDUCATION** : Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's Degree in Nursing. **OR**… more
- Molina Healthcare (Buffalo, NY)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… more
- Catholic Health (Kenmore, NY)
- …7a-7p/11a-11p/ 3p-3a/ 7p-7a/follows preceptor and classroom schedule Summary: The Nurse Residency position offers training, education and professional development ... Intensive Care Unit (ICU), or Cardiovascular Intensive Care Unit (CVICU). The nurse resident systematically and continuously assists in the collection and assessment… more
- Travelers Insurance Company (Buffalo, NY)
- …**What Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for ... you do and where you do it. **Job Category** Nurse - Medical Case Manager **Compensation Overview** The annual...to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria. **What Will You Do?**… more
- Molina Healthcare (Buffalo, NY)
- …Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Molina Healthcare (Buffalo, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Catholic Health (Buffalo, NY)
- …Two (2) years acute care RN experience required + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or Disease ... Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New...Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New… more
- Catholic Health (Buffalo, NY)
- …(2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or ... Hours: 8:00-4:oopm with rotation to 10:00-6:00pm Summary: The Registered Nurse (RN) Care Manager-Transition of Care, as an active...Education, or BS in Health related field + Registered Nurse , licensed (unrestricted) in New York State + New… more
- Molina Healthcare (Buffalo, NY)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- Molina Healthcare (Buffalo, NY)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Molina Healthcare (Buffalo, NY)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
- Kaleida Health (Buffalo, NY)
- …2 years of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interqual Criteria set ... with members of the interdisciplinary team to coordinate care, facilitate utilization and resource management and discharge planning functions, working to achieve… more
- Kaleida Health (Williamsville, NY)
- …2 years of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interqual Criteria set ... with members of the interdisciplinary team to coordinate care, facilitate utilization and resource management and discharge planning functions, working to achieve… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex ... management rounds. + Provision of clinical oversight and leadership to Utilization Management/Case Management (UM/CM) staff working with the children's population. +… more
- STG International (West Seneca, NY)
- …safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... Participate in the orientation of clinical staff physicians, physician assistants and nurse practitioners. + Provide leadership to CBOC clinicians. + Evaluate the… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …Part II, Appendix G. The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical… more
- Molina Healthcare (Buffalo, NY)
- …for opportunities to improve efficiency, productivity, effectiveness, and accuracy. * Review , research, analyze and evaluate information to assess compliance between ... need (up to 25%) **Job Qualifications** * Active and unrestricted Registered Nurse (RN) license or independent behavioral health license (LCSW, LPC, LMFT, or… more