- New York State Civil Service (New York, NY)
- …Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 Occupational Category Health Care, Human/Social Services ... York State NY Zip Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily … more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- CenterWell (Albany, NY)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- WMCHealth (Valhalla, NY)
- …of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical Center. Depending ... Asst Utilization Coordinator Company: Westchester Medical Center...of which must have been in the area of utilization review , quality assurance, risk management or… more
- Mount Sinai Health System (New York, NY)
- …State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts + Obtains/Prepares Medical Records and other documentation ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...record keeping. Responsible for accurate filing of records, obtaining medical records and mailing of both internal and external… more
- Elevance Health (Middletown, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location:** Virtual: This role...responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing… more
- Centene Corporation (New York, NY)
- …teams on utilization processes to promote high quality and cost-effective medical care to members + Provides feedback on opportunities to improve the ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Molina Healthcare (NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Bassett Healthcare (Cooperstown, NY)
- …enjoy the best quality of life possible. What you'll do The Registered Professional Nurse II, Acute Care is accountable for the delivery of safe patient care ... no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. Analyzes assessment data to… more