- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse I Department: Utilization Management...for all payers. Demonstrates fiscal responsibility. + Prepare the UM review findings, initiate and 1st, 2nd,… more
- Healthfirst (NY)
- …or equivalent work experience + NYS RN + Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations ... concurrent review , and service requests + Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers,… more
- Molina Healthcare (Albany, NY)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Buffalo, NY)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization… more
- University of Rochester (Rochester, NY)
- …record. Other duties as assigned. **MINIMUM EDUCATION & EXPERIENCE** + Associate's degree Registered Nurse ( RN ) required + Bachelor's degree in Nursing ... through query processes. + Provides oversight for EPARC, including UM work queues and unbilled work queues. + Communicates...HDM, Cobius, and Sharepoint preferred **LICENSES AND CERTIFICATIONS** + RN - Registered Nurse -… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Centene Corporation (New York, NY)
- …Licensure. Hours are M-F 8:30 am - 5:00 pm with holiday rotation.** **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State ... fresh perspective on workplace flexibility. **Applicants must possess NY RN State Licensure. Hours are M-F 8:30 am -... Review , and/or Retrospective Review Clinical Review team to ensure appropriate care to… more
- Evolent (Albany, NY)
- …medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum ... for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification...of experience with medical management activities in a managed care environment + UM /UR experience + Clinical… more
- Elevance Health (Latham, NY)
- Behavioral Health Care Manager I- Behavioral Health Care Manager I **Locations:** The selected candidate must reside within a reasonable commuting distance of ... is granted as required by law. The **Behavioral Health Care Manager I** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more