- Albany Medical Center (Albany, NY)
- …America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. * Completes ... Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- City of New York (New York, NY)
- …equity-driven, engaging, and responsive. We're looking for a motivated and mission-aligned Nurse Practitioner Medical Director to help lead that vision. DUTIES ... now available within the Division of Administration, Offices of Clinical Quality Management and Improvement/Employees' Health Program. We're building an Employee… more
- Centene Corporation (New York, NY)
- …contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of ... to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members + Provides feedback… more
- Centene Corporation (New York, NY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
- Centene Corporation (New York, NY)
- …contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of ... to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members + Provides feedback… more
- CVS Health (Albany, NY)
- …And we do it all with heart, each and every day. **Position Summary** The Quality Management Nurse (QM Nurse ) supports Aetna Better Health of Texas ... quality initiatives. This role combines clinical expertise with quality improvement leadership, including clinical documentation review , Performance… more
- Bassett Healthcare (Cobleskill, NY)
- …Schoharie County and the surrounding region What you'll do The Registered Professional Nurse (RN), Acute Care in the Medical Inpatient Unit is accountable ... we serve, and our communities, achieve optimum health and enjoy the best quality of life possible. About the department "Why Cobleskill Regional Hospital? Part of… more
- Mount Sinai Health System (New York, NY)
- … Nurse for the Mount Sinai nursing float pool is a Registered Professional Nurse who provides safe, competent quality care based on nursing theory and ... application Licensing and Certification Requirements (if applicable) Licensed as a registered nurse with current registration in New York State Name: Basic Life… more
- Bassett Healthcare (Cooperstown, NY)
- …population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible. What you'll do The Registered Professional Nurse ... no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. + Analyzes assessment data… more