- Centene Corporation (New York, NY)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA… more
- Albany Medical Center (Albany, NY)
- …by assuring communication with Triad Team and health care team. Minimum Qualifications:* Registered nurse with a New York State current license.* Bachelor's ... documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts… more
- Fresenius Medical Center (Camillus, NY)
- …Report any significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine ... policy. Report any change or unusual findings to the registered nurse or supervisor. + Perform and...+ Monitors patients performing self-care under the supervision of RN . Assists patients in performing self-care as applicable **Staff… more
- Fresenius Medical Center (Niskayuna, NY)
- …Report any significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine ... policy. Report any change or unusual findings to the registered nurse or supervisor. + Perform and...+ Monitors patients performing self-care under the supervision of RN . **Staff Related** + Assists in training of applicable… more
- Centene Corporation (New York, NY)
- …and Certifications:** A license in one of the following is required: Licensed Registered Nurse ( RN ), Licensed Clinical Social Worker (LCSW), Licensed ... in Interrater Reliability meetings. Aids in efforts to continuously develop review tools to ensure validity of criteria, and appropriately captures evidence… more
- New York State Civil Service (Syracuse, NY)
- …consists of candidates who have 1 year of permanent service as a Registered Nurse Supervisor 1 Psychiatric. Additional Comments All OMH employees receive ... Psychiatric if they have:* Possession of a license and current registration as a registered professional nurse in New York State; and* Bachelor's degree in… more
- Healthfirst (NY)
- …+ Clinical license: LPN, RN , LMSW or LCSW + Multiple years of HEDIS review experience for both Medicaid and Medicare lines of business + Medical record ... management + Assists in writing member and/or provider articles on HEDIS, QARR, Medicare Advantage, and/or health promotions for the HF newsletter + Assists and… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …peer-to-peer calls in timely manner and provides support for the Case Management (CM) and Registered Nurse ( RN ) reviewers and manages the denial process. + ... the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. + Collaborates with Provider Relations...without restrictions and free of sanctions from Medicaid or Medicare required. + Minimum of five (5) years of… more
- Catholic Health Services (Smithtown, NY)
- …Nursing (BSN) degree required Master of Science degree strongly preferred Licensure: New York Registered Nurse ( RN ) License & Registration Salary Range USD ... nursing supervisors will report to them. The Director of Care Management and Nurse Operations will: Work collaboratively with, but not limited to, Medical Staff,… more
- Arnot Health (Elmira, NY)
- …an approved registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three years ... the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge...and stay in accordance with Interqual. ** 2. Prepares Medicare /Non Medicare hospital notices of noncoverage (HINN)… more