- Healthfirst (NY)
- …Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management /case management . ... This position is 100% Remote . We are hiring for the following schedules...process + Additional duties as assigned Minimum Qualifications: + RN , LPN OR Dental Hygienist Preferred Qualifications: + Bachelors… more
- Centene Corporation (New York, NY)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- VNS Health (Manhattan, NY)
- …years' experience in a Grievance and Appeals or related area such as medical or utilization management in a Managed Care setting required + Experience in a ... Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of our grievance and...+ License and current registration to practice as a registered professional nurse in New York State… more
- Molina Healthcare (Albany, NY)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- Sharecare (Albany, NY)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager....will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
- Arnot Health (Elmira, NY)
- … Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have proficient ... Job Description Remote work available! Up to $10,000 Sign on...Bonus for qualified Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review and appeal as appropriate… more
- SUNY Upstate Medical University (Syracuse, NY)
- …field) and a minimum of three years RN post-licensure nursing experience or RN Utilization Management , or Associate's Degree in Nursing and five years ... Job Summary: The Utilization Review/Quality Assurance Sr. Coordinator will be responsible...federal regulations and all CMS activities. Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelors Degree in… more
- Lincoln Financial (Albany, NY)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee residing outside...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… more
- Teleflex (Rochester, NY)
- …based Sales Representative, Anesthesia, is making connections with anesthesiologists, Certified Registered Nurse Anesthetist's (CRNA's), other members of the ... our world-class brands including: + LMA(R) and Rusch(R) airway management devices designed to help reduce the risk of...business plan. * Grow overall market share and increase utilization among existing accounts, while securing new users within… more
- CVS Health (Albany, NY)
- …visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the member experiences a ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...or changes in condition to be transitioned back to RN . + Complete post discharge call and required assessments… more
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