- Centene Corporation (New York, NY)
- …license.** **Inpatient Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical ... between utilization management team, members, and providers + Monitors prior authorization, concurrent review , and/or retrospective clinical review nurses… more
- Mount Sinai Health System (New York, NY)
- …clinical information requested by the managed care companies as part of the concurrent review in a timely fashion. 13. Provides clinical information requested ... preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a… more
- Northwell Health (Forest Hills, NY)
- …Masters Degree, preferred.Current license to practice as a Registered Professional Nurse in New York State.Patient Review Instruments (PRI) Certification, ... etc 2. are appropriately arranged for and financially approved.Performs concurrent utilization management.Reviews appropriateness of patient's admission, need for… more
- Rochester Regional Health (Rochester, NY)
- …necessary and delivered at the most appropriate level; actively participate in the concurrent review process and communicate/intervene with third party payors to ... SUMMARY As a Registered Nurse - Care Manager, your excellent interpersonal, leadership...managed care payment principles helpful RESPONSIBILITIES + Evaluation & Review . Evaluate hospital admissions to assure care is medically… more
- Kaleida Health (Buffalo, NY)
- …team, Nursing, Patient Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data.The ... of the health care team. The CDS is also responsible for audit review to identify potential documentation deficiencies in specific records and to identify clinical… more
- University of Rochester (Rochester, NY)
- …reviewing patient charts for additional data indicators, and completion of concurrent data abstraction. + Coordinate with other program staff, departments, and ... for the Pediatric Trauma Program including Pediatric Multidisciplinary Trauma Peer Review and Trauma Systems and Operations Committee meetings + Attends weekly… more
- Kaleida Health (Buffalo, NY)
- …team, Nursing, Patient Management, Quality Department and ancillary staff to perform concurrent analytical review of clinical documentation and coding data. ... and other members of the health care team. Also responsible for audit review to identify potential documentation deficiencies in specific records and to identify… more
- MVP Health Care (Rochester, NY)
- …the Medical Director to ensure appropriate outcomes. + Service Authorization & Review : Conduct prospective, concurrent , and retrospective reviews to determine ... + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
- Molina Healthcare (Yonkers, NY)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more
- Mount Sinai Health System (New York, NY)
- …The Senior Risk Manager supports the Risk Management staff on how best to review risk management data, conduct Root Cause Analysis, and comply with risk management ... + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign healthcare… more