- Northwell Health (Staten Island, NY)
- …care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness ... + Current license to practice as a Registered Professional Nurse in New York State. + Case Management... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more
- Guthrie (Binghamton, NY)
- …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care...in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to… more
- Mount Sinai Health System (New York, NY)
- …to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using standardized ... **Job Description** **RN/Case Manager MSH Case Management PT Days** The Case Manager (CM) will...Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, process and procedures ensuring accurate member care ... Supervisor is responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... - SNH is responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include… more
- Catholic Health (Buffalo, NY)
- …Care Hospital Setting + Minimum five (5) years of experience working within Utilization Review /Case Management /Clinical Documentation Integrity or + Minimum ... Cycle and interdisciplinary care team and works in conjunction with the Utilization Review Manager and Manager Clinical Documentation Integrity. The Middle… more
- Molina Healthcare (Yonkers, NY)
- …room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Kaleida Health (Buffalo, NY)
- …In addition to daily oversight of operations, the VP will partner with Utilization Review , Revenue Cycle, and Clinical leadership to create patient/family ... Business field preferred. RN licensure required.** **Experience** **10 years of care management / utilization management experience required in hospital and/or… more
- Molina Healthcare (Rochester, NY)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- Mohawk Valley Health System (Utica, NY)
- …of disease and patient management . Preferred: + Knowledge of Quality Management , Performance Improvement and Utilization Management requirements and ... Department: QUALITY IMPROVEMENT Job Summary The Quality Professional is a Registered Nurse with clinical experience in Med/Surg, Critical Care and other acute care… more