- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Evolent (Albany, NY)
- …Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- City of New York (New York, NY)
- …health standards for children in foster care. The New Admissions Focused (NAF) Nurse Reviewer will be responsible for: 1. Scheduling and conducting NAF ... 5 boroughs 2. Participating in all post medical record review quality monitoring and corrective action processes 3. Conducting...subject of a child abuse and maltreatment report. STAFF NURSE - 50910 Qualifications 1. A valid New York… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks ... cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Catholic Health (Buffalo, NY)
- …EDUCATION + Graduate of an accredited School of Nursing + Bachelor of Science in Nursing (BSN) preferred + Current New York State RN license + Valid drivers license ... Salary: 67,606.50-101,419.50 USD Facility: Administrative Regional Training Cntr Shift: Shift 1 Status: Full Time FTE: 1.000000 Bargaining Unit: ACE Associates Exempt from Overtime: Exempt: Yes Work Schedule: Days Hours: 8:00am-4:00pm Summary: Conducts audits… more
- Elevance Health (New York, NY)
- **Case Reviewer (NP/PA)** **Carelon Medical Benefit Management** **Orthopedic Surgery** **Virtual:** This role enables associates to work virtually full-time, with ... unless an accommodation is granted as required by law._ The **Case Reviewer ** is responsible for conducting pre-authorization, out of network and appropriateness of… more
- SUNY Upstate Medical University (Syracuse, NY)
- …the Patient Relations department with patient complaints that require quality review and/or Risk oversight. Minimum Qualifications: Registered Nurse , NYS ... Job Summary: High-level clinical review of patients admitted to the University Hospital...risk identification and referral to clinical departments for ongoing review of quality improvement focused on the support of… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Description of Duties This position is in the Utilization Review Unit and functions as an assessment nurse... Review Unit and functions as an assessment nurse . This is a professional nursing position involving responsibility… 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 review ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more