- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... documentation and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works… more
- Guthrie (Binghamton, NY)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... Arts (BA) degree in addition to a degree in Nursing . A registered nurse with five (5)...admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b.… more
- Ellis Medicine (Schenectady, NY)
- …is to work with the Social Worker, Nurse Case Manager , or Utilization Management Nurse to facilitate patient discharge plans, support coordination of ... beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . + Utilization Management Activities: + Collaborates with Case… more
- Guthrie (Binghamton, NY)
- …State of Pennsylvania/New York. Certification within area of expertise or practice preferred ( Nursing Management , CCRN, CEN, etc.) BSN required within 3 years of ... impact on practice in the planning and delivery of nursing and other services. + Utilizes staffing management...+ Manages daily staffing issues in conjunction with Charge Nurse / Nurse Manager , analyzing… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a...additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization /appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors and/ ... and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
- Rochester Regional Health (Rochester, NY)
- …Week: 40Schedule: M-F Days, with flexibility to work night/off shift SUMMARY:The Assistant Nurse Manager (ANM) is responsible for the clinical care to patients ... ANM is the main contact for a variety of nursing functions in support of management and...resolve patient or family concerns in collaboration with the Nurse Manager /Director; promote optimal care through internal… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for...given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Rochester Regional Health (Rochester, NY)
- …and direct oversight of day-to-day responsibilities of nursing team members. The Assistant Nurse Manager is the main contact for a variety of nursing ... M-F- 7-330pm, 8-430pm, or rotating with evening hoursSUMMARY:The Assistant Nurse Manager is responsible for the clinical...within practice areao Completes at least one clinical research utilization (CRU) form for submission to Nursing … more
- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...(IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of… more
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