- Guthrie (Cortland, NY)
- …than one year of experience) Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician ... offices, and the Robert Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for reimbursement of patient care services. The responsibilities… more
- Evolent (Albany, NY)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Nuvance Health (Poughkeepsie, NY)
- *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management, Infection ... program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate.… more
- Molina Healthcare (Buffalo, NY)
- …**Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory ... and reports quality of care issues. + Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review , appropriate… more
- Albany Medical Center (Albany, NY)
- …documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.* Facilitates removal of delays and documents… more
- Bassett Healthcare (Cooperstown, NY)
- …specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Operating Room / Perioperative Services unit ... needs. The RN contributes to the support of patients through interdisciplinary teamwork. + Registered Nurse I: The RN I status is only appropriate for a new nurse… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title - Nurse Practitioner- ADS Telemetry - Mount Sinai Hospital - Full Time - Night** A nurse practitioner (NP) as described in Title ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more
- Mount Sinai Health System (Long Island City, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and...the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion… more