- Centene Corporation (New York, NY)
- …of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Molina Healthcare (Yonkers, NY)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... unrestricted State Registered Nursing (RN) license in good standing. Must be licensed for CALIFORNIA. **WORK SCHEDULE: California NON RESIDENTS must work CALIFORNIA… more
- Molina Healthcare (Rochester, NY)
- …state or locality with reliable transportation. **State Specific Requirements:** IL Qualifications: Licensed within the state of Illinois or will apply for licensure ... or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
- New York State Civil Service (Syracuse, NY)
- …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... Description * Provide professional psychological services under the supervision of a licensed psychologist or other appropriate licensed clinician; * Develop and… more
- Rochester Regional Health (Rochester, NY)
- …necessity in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay ... in the expected time frame and with most efficient utilization of resources. Carries out activities related to ...continuum. + Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based… more
- Outreach Development Corporation (Brentwood, NY)
- …with regard to tracking, reporting and outcome objectives, including ongoing internal review of service delivery. . Assist with coordination, training and support to ... as directed by the Site Director. . Implement vocational services and promote utilization of staff that serves to enhance program utilization , service delivery… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision… more
- Molina Healthcare (Yonkers, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... are seeking a (RN) Registered Nurse who must be licensed for the state they reside This position will...the state they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer… more
- Catholic Health Services (Melville, NY)
- …Initiatives Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical ... York, as applicable. Certification by American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred. 4. Knowledge, Skills and… more
- CDPHP (Albany, NY)
- …clear understanding of prescription and medical benefits as it applies to the utilization review process. + Must demonstrate proficient experience with the ... be a part of that experience. Under the direct supervision of a licensed pharmacist, the Managed Care Pharmacy Technician (Pharmacy Tech) is responsible for… more