- Molina Healthcare (Buffalo, NY)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... teams to promote Molina Care Model + Adheres to UM policies and procedures. **JOB QUALIFICATIONS** **Required Education** Any...of the following: Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)… more
- Molina Healthcare (Syracuse, NY)
- …Utilization Review Lead responsibilities also include but not limited to, collaborate with UM Leadership to ensure the Daily Auth Reconciliation Report (DARR) is run ... **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Licensed Registered Nurse (RN), Licensed Vocational Nurse (LVN), or Licensed Practical… more
- Sharecare (Albany, NY)
- …new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical , dental, and ... present premier provider options, including but not limited to medical , dental, and vision plans + Support for spending...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Elevance Health (Latham, NY)
- …and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data entry of referral requests ... into the UM system in accordance with the plan certificate. +...an equivalent background. **Preferred Skills, Capabilities and Experiences** + Medical terminology training and experience in medical … more
- Independent Health (Buffalo, NY)
- …coordinate post inpatient BH treatment continuity. + Collaborate with other departments such as Medical UM , Medical Case Management, and SIU for specific BH ... counselor (LPC), licensed family or marriage therapist (LMFT) or active registered nurse (RN) in NYS required. Certified Case Manager (CCM) required. Candidates… more
- Molina Healthcare (Albany, NY)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …(ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, Geriatrics, etc.) to ensure ... + Case Management Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required to know multiple functional… more
- Stony Brook University (Stony Brook, NY)
- …as required. **Qualifications** **Required** : Current NYS RN. A Bachelor's degree or a nurse working on their degree with an RN license and working history of 5 ... be able to prioritize their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge of MCG or Interqual… more