- CenterWell (Albany, NY)
- … clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Trinity Health (Syracuse, NY)
- …department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) actively manages ... the utilization review process and patient progression from Admission to Discharge....Practice Act, National Standards of Practice, and Nursing and Clinical Service standards of care and practice.… more
- Mount Sinai Health System (New York, NY)
- …and department administrators to ensure that clinical practice, systems are supportive of clinical care . + Promotes utilization of APNs to optimize their ... Health. The APP Manager-Nursing supervises the optimization of APN clinical practice within a service line for the delivery...meetings and conferences to enhance an interdisciplinary approach to care delivery. + Performs a patient record review… more
- Guthrie (Binghamton, NY)
- …care services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
- Centene Corporation (New York, NY)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all ... and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone...Psychology or Clinical Social Work. Three years clinical experience in a health care environment;… more
- Centene Corporation (New York, NY)
- …flexibility. **Must be licensed in the state of New York.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Hospital Description of Duties This position is in the Utilization Review Unit and functions as an...nursing care that may include bedside and/or clinical care to convalescent, chronically ill, and… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for ... + Demonstrated ability to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must be… more
- Catholic Health Services (Melville, NY)
- …clinical expertise/reference for specialty services as needed to adequately prepare clinical review and/or appeal. Demonstrates aptitude and skill in applying ... was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical... to MCC in response to physician order, or review of updated clinical information Acts as… more
- Molina Healthcare (Syracuse, NY)
- …preferred. **Preferred Experience** 3-5 years clinical practice with managed care , hospital nursing, utilization and/or care management experience. ... role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate… more