- 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 ... assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Centene Corporation (New York, NY)
- …related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization… more
- Datavant (Albany, NY)
- …job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus. Minimum… more
- BronxCare Health System (Bronx, NY)
- …and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate preferred . ... and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients,… more
- Bassett Healthcare (Cooperstown, NY)
- …p ositive results + Works collaboratively with unit staff (charge nurse , staff nurse ) unit manager, and support team ( UM , MSW, SW, etc) to progress each ... life possible. What you'll do The Manager for Case Management and the Logistics Center is responsible for the...+ NYS Licensed Social Worker, required + Current NYS RN License if RN , required + Required… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review, obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely...for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call… more
- MVP Health Care (Tarrytown, NY)
- …you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after ... our Talent team at ###@mvphealthcare.com . **Job Details** **Job Family** ** Medical Management /Clinical** **Pay Type** **Salary** **Hiring Min Rate** **56,200… more
- Evolent (Albany, NY)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices of...under the auspices of the office of the Chief Medical Officer. **ESSENTIAL DUTIES AND RESPONSIBILITIES** : include the… more
- Highmark Health (Albany, NY)
- …:** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a ... in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing...in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and… more
- CVS Health (Albany, NY)
- …years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management ( UM ) and Case Management ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more