- Centene Corporation (New York, NY)
- …Provider. + Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using ... a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient and… more
- CVS Health (Albany, NY)
- …At least 1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in ... healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply critical… more
- aptihealth (Clifton Park, NY)
- …the appropriate care team member + Assist prescribers with medication prior authorization , coordination with pharmacy, medication refill requests, ... in being diverse and inclusive The Role The Registered Nurse Case Manager team at AptiHealth is pivotal to...Bachelor's degree preferred + Currently licensed as a Registered Nurse in New York + Current Certified Case Manager… more
- Spectrum Health and Human Services (Buffalo, NY)
- …treatment, rehabilitative, and support services matters (eg, AOT, Social Security applications, prior authorization of mediation, etc.). + Participate in and ... POSITION FUNCTION: As a member of the multi-disciplinary team, the Psychiatric Nurse Practitioner PMHNP in conjunction with the clinical team, has overall clinical… more
- Albany Medical Center (Albany, NY)
- …bed access/team approach (ICU or floor admitting MD/Pharmacy/ Nurse Manager/Clinical Nurse Specialist/Consulting MD), prior authorization , protocols for ... bed access/team approach (ICU or floor admitting MD/Pharmacy/ Nurse Manager/Clinical Nurse Specialist/Consulting MD), prior authorization , protocols for… more
- Bassett Healthcare (Oneonta, NY)
- …back learning to the team, and is a go to person for coworkers. Obtains prior approval or prior authorization as needed. Communicates referral appointment ... or expressed patient problems directly to Supervisor or Supervising Nurse for assistance as observed by Supervisor and Supervising...signatures and form processing to meet Medicare regulations. Obtains prior approval or prior authorization … more
- Guthrie (Corning, NY)
- …safe and timely dispensing of the medication for the patient as needed. Medication Prior Authorization * *Collect necessary documentation and submit it to the ... in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience in nursing,… more
- Molina Healthcare (Syracuse, NY)
- …a compact licensure. The ideal candidate will have experience with UM and prior authorization , within both Physical Health and Behavioral Health. Candidates with ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Ellis Medicine (Schenectady, NY)
- …The Discharge Planner's primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge ... in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, updating… more
- Bassett Healthcare (Cooperstown, NY)
- …matter expert in registration functions. Attends Patient Access Review Sessions (PARS) Obtains prior approval or prior authorization as needed. Communicates ... up emergent situations or expressed patient problems directly to Supervisor or Supervising Nurse for assistance as observed by Supervisor and Supervising Nurse … more