• Utilization Management Behavioral…

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
    Humana (03/18/25)
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  • Care Manager RN (Delaware) Remote

    Highmark Health (Albany, NY)
    …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN more
    Highmark Health (02/20/25)
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  • Pre-Authorization Registered Nurse

    Humana (Albany, NY)
    …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
    Humana (03/15/25)
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  • Registered Nurse - Critical Care…

    Veterans Affairs, Veterans Health Administration (Albany, NY)
    …Former EDRP participants ineligible to apply. Responsibilities The Critical Care Registered Nurse is responsible for providing competent, evidence-based care ... equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion… more
    Veterans Affairs, Veterans Health Administration (03/14/25)
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  • Registered Nurse - Med/Surg

    Veterans Affairs, Veterans Health Administration (Albany, NY)
    …application. Former EDRP participants ineligible to apply. Responsibilities The Inpatient Staff Registered Nurse ( RN ) is responsible for providing competent, ... orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
    Veterans Affairs, Veterans Health Administration (02/01/25)
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  • Utilization Management RN

    Ellis Medicine (Schenectady, NY)
    Basic Function: The Utilization Management Registered Nurse (UM RN ) supports daily coordination of care across healthcare continuum with the ... preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN...care related field required. Current registration as a Licensed Registered Professional Nurse in New York State.… more
    Ellis Medicine (01/02/25)
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  • Case Manager (Inpatient Units)

    Ellis Medicine (Schenectady, NY)
    …for appropriate Level of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional ... RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This...the Case Manager include, but are not limited to, utilization review , case management , care… more
    Ellis Medicine (03/14/25)
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  • Utilization Review Nurse

    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 Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of… more
    CDPHP (03/12/25)
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  • Medical Management Nurse

    Elevance Health (Latham, NY)
    …commute to the Elevance Health major office (PulsePoint) location listed above. The **Medical Management Nurse ** is responsible for review of the most ... **Medical Management Nurse ** **Office Location** : Atlanta,...experience and requires a minimum of 2 years clinical, utilization review , or case management more
    Elevance Health (03/13/25)
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  • RN -Education Spec-Clin Center for Learning…

    Albany Medical Center (Albany, NY)
    …in the field of Clinical Social Work or Nursing with experience in Case Management , Utilization Review and Discharge Planning. * BLS Certification. * ... principles of conflict resolution and promote consensus building.* Represents Case Management /Social Work at organizational committee meetings as directed* Serves as… more
    Albany Medical Center (03/04/25)
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  • Manager, Utilization Management

    Humana (Albany, NY)
    …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
    Humana (03/12/25)
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  • RN - HIV Medicine Practice

    Albany Medical Center (Albany, NY)
    …Aids Program Work Shift: Day (United States of America) Salary Range: $60,028.00 - $99,023.00 Registered Nurse ( RN ) - Part Time HIV Medicine Clinic - Albany, ... advanced practice provider (APP) and the supervision of the Nurse Manager ( RN ) and/or Nurse ...program is required * Current NYS license as a Registered Nurse is required * Minimum of… more
    Albany Medical Center (02/21/25)
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  • RN Uniform System Assessor field travel…

    Molina Healthcare (Albany, NY)
    …* UAS experience * Experience conducting home visits Required Licensure or Certification: * Registered Nurse ( RN ) State Specific Requirements: * Must reside ... for Medicaid and Medicare. We are looking for a RN candidate with a Uniform System Assessor (USA) background....medical equipment (DME). * Experience in utilization review , concurrent review and/or risk management more
    Molina Healthcare (03/19/25)
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  • RN Clinical Manager

    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...NY State requirements. + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (02/19/25)
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  • RN Admissions Facilitator - Skilled Nursing…

    Trinity Health (Albany, NY)
    …other related duties as assigned Experience and Requirements + Active Licensure as a registered nurse , preferably with a **bachelor's degree** in nursing from an ... Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals...accredited school and Certified Registered Rehab Nurse preferred (CRRN). + A… more
    Trinity Health (01/28/25)
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  • RN Clinical Consultant

    Guardian Life (Albany, NY)
    …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
    Guardian Life (03/15/25)
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  • RN Medicare Compliance

    Sedgwick (Albany, NY)
    …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more
    Sedgwick (02/14/25)
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  • Public Health Program Nurse (NY Helps)

    New York State Civil Service (Albany, NY)
    …packages such as Microsoft Office, Outlook, etc. Additional Comments Current registration as a Registered Nurse ( RN ) with the New York State Education ... New York State license and registration as a professional registered nurse AND four years of post-licensure...experience include, but are not limited to, discharge planning, utilization review , treatment plan development for individuals… more
    New York State Civil Service (03/08/25)
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  • Medical Management Clinician Associate (US)

    Elevance Health (Latham, NY)
    …following standard procedures that do not require the training or skill of a registered nurse . **How you will make an impact** Primary duties include, but ... **Medical Management Clinician Associate** **Location:** The ideal candidate will...a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid… more
    Elevance Health (03/13/25)
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  • Nurse Case Manager - Full Time, DAYS

    Albany Medical Center (Albany, NY)
    …proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to ... the referral process and use of community resources. 2. Utilization Review a. Reviews data from admission...strategies for variance reduction. Qualifications and Ideal Characteristics 1. Registered nurse with a current license. 2.… more
    Albany Medical Center (03/08/25)
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