- CDPHP (Albany, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- 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 ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for… more
- Elevance Health (Latham, NY)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative I** **Virtual:** This role enables...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Molina Healthcare (NY)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity...of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short… more
- Molina Healthcare (Yonkers, NY)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Mohawk Valley Health System (Utica, NY)
- …SNH is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. Duties include the ... Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member care needs… more
- Guthrie (Corning, NY)
- …a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or BA degree ... two (2) years of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who holds a bachelor's degree in a related… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …medical Referral Documents (REFDOC) as required for scheduling care. Enters CC authorization into Health Share Referral Manager (HSRM) database as per FGB and ... local guidelines; provides written authorization to community provider and patient. Obtains medical records...subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested… more
- Arnot Health (Elmira, NY)
- …Assists in tracking/trending by payer for denial reason items such as prior authorization , untimely filing, coordination of benefits, services type issues, ... on Bonus for qualified Case Managers! MAIN FUNCTION: The Case Management (denial/ prior auth) will review and appeal as appropriate for concurrent and retrospective… more