- Stony Brook University (Stony Brook, NY)
- …+ Coordinates the design, development, implementation and monitoring of the organizations case management and utilization review functions. + Manages daily ... but are not limited to:** + Responsible for addressing Utilization management , denials and appeal, discharge and... of resources, coordination of care across the continuum, utilization review , discharge and transition planning and… more
- Stony Brook University (Stony Brook, NY)
- … Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were… more
- CVS Health (Albany, NY)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review… more
- Cognizant (Albany, NY)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Crouse Hospital (Syracuse, NY)
- …health education and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage ... Schedule: Full Time: 8:00am-4:30pm, requires 6 weekends a year. Utilization Management Registered Nurse (RN)...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- CDPHP (Latham, 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 ... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… 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 ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on… more
- Independent Health (Buffalo, NY)
- …credentials preferred. + Four (4) years of clinical experience required. Utilization Management experience preferred. + Comprehensive knowledge and experience ... The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in… more
- Lincoln Financial (Albany, NY)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Centene Corporation (New York, NY)
- …requires NY RN Licensure as well as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a… more
