- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them...system. + Identifies and refers potential cases to Disease Management , Case Management , Demand … more
- Rochester Regional Health (Rochester, NY)
- …clinical problem solving. REQUIRED QUALIFICATIONS: + 3 years of acute hospital care, Case Management and/or Utilization Management experience + ... Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital...with minimum direction. + Act as a resource for utilization review stakeholders and assists team members… more
- WMCHealth (Valhalla, NY)
- …of Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. + Reviews cases for medical ... and/or appeals agency preferred. Previous utilization management , case management or peer review documentation experience in hospitals or health… more
- Mount Sinai Health System (New York, NY)
- …Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West...Insurance / State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts… more
- Mount Sinai Health System (New York, NY)
- …limited to: a Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using ... **Job Description** **RN/ Case Manager MSH Case Management...in homecare, long term care or utilization review preferred. + Discharge Planner or Case … more
- Arnot Health (Elmira, NY)
- …to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... is BSN prepared will be a leader in the Case Management practice. The Case ...care hospital setting or two years utilization management in an acute care hospital setting. Case… more
- Mohawk Valley Health System (Utica, NY)
- … Management - SNH is responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. ... of the case manager's daily operations of utilization review practice, processes and procedures ensuring...day to day operation of the Case Management department. + Assists with identifying over- utilization … more
- Guthrie (Binghamton, NY)
- …experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management certification or obtain a ... case reimbursement. a) Identifies cost/clinical outlier patients for intensive case management and facilitates evaluation of alternative care options. b)… more
- Guthrie (Corning, NY)
- …Has an understanding of the regulatory requirements relative to the case management process. Certified to complete Patient Review Instruments (PRIs). Has a ... working knowledge of the hospital computer system as it relates to case management . Essential Functions: 1. Assists to ensure that the right care is provided to… more
- Northwell Health (Staten Island, NY)
- …care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness ... of patient care outcomes. + Submits data to management regarding case management and/or... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more