- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …application. Former EDRP participants ineligible to apply. Responsibilities The Inpatient Staff Registered Nurse ( RN ) is responsible for providing competent, ... orientation, competencies and providing quality improvement and enhance outcomes utilization . This nurse integrates knowledge, skills, abilities,...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Centene Corporation (New York, NY)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Molina Healthcare (NY)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . * Incorporate leadership and communication skills to work ... care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted State Registered Nursing ( RN ) license in good standing. **PREFERRED… more
- Centene Corporation (New York, NY)
- …a fresh perspective on workplace flexibility. Applicants must possess NY RN State Licensure **Position Purpose:** Analyzes all prior authorization requests to ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more
- CenterWell (Clifton Park, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...NY State requirements. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (Buffalo, NY)
- …* UAS experience * Experience conducting home visits Required Licensure or Certification: * Registered Nurse ( RN ) State Specific Requirements: * Must reside ... for Medicaid and Medicare. We are looking for a RN candidate with a Uniform System Assessor (USA) or...and using durable medical equipment (DME). * Experience in utilization review , concurrent review and/or… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and… more
- Guthrie (Johnson City, NY)
- …data analysis and process outcome evaluation. Education, License & Cert: Licensed Registered Nurse with 5 years' experience, preferably in an ... applicant must have a current license as a Professional Registered Nurse in their state of practice...in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced… more
- Healthfirst (NY)
- …in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. + Demonstrated ... This position is 100% Remote . We are hiring for the following schedules...understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual,… more
Recent Jobs
-
Envista Manager, IT Vendor Management (Hybrid-Brea, CA)
- Envista Holdings Corporation (Brea, CA)
-
Assessment/Curriculum Administrator
- COCC (Bend, OR)