- Molina Healthcare (Yonkers, NY)
- …Nurse who be licensed in the state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home ... integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical… more
- Catholic Health (Buffalo, NY)
- …Holiday Rotation Hours: 8:00 am to 4:00 pm Summary: The Registered Nurse (RN) Care Manager - Utilization Review , as an active member of the Care Management ... clinical skills and discharge planning principles, the RN Care Manager , Utilization Review collaborates with...obtained within 6 months + National Certification in Case Management preferred EXPERIENCE + Two (2) years medical surgical… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the...care to MCC in response to physician order, or review of updated clinical information Acts as a resource… more
- Evolent (Albany, NY)
- …contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Utilization ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as...to determine if submitted requests require a prior authorization review or redirect as required. + Entering data into… more
- Mount Sinai Health System (New York, NY)
- …+ Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ... **Job Description** **RN/Case Manager MSH Case Management FT Days**...new admissions to identify patients where utilization review , discharge planning, and/or case management will… 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 ... BSN prepared will be a leader in the Case Management practice. The Case Manager will work...nursing in acute care hospital setting or two years utilization management in an acute care hospital… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Case Manager is responsible for all aspects of case management / utilization review for an assigned group of inpatients, ED ... in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager...new admissions to identify patients where utilization review , discharge planning, and/or case management will… more
- Crouse Hospital (Syracuse, NY)
- …day management of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing ... outreach programs. Crouse's Care Coordination team is hiring a Manager who is responsible for providing day to day...acute care discharge planning + Preferred - Acute care utilization review experience Benefits Overview: + Medical,… 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 ... and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates… more