- Evolent (Albany, NY)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Arnot Health (Elmira, NY)
- Job Description Up to a $25,000 Sign on Bonus for qualified Registered Nurses *Terms of payment may vary based on experience* Are you ready to join an organization ... and advancement opportunities. We welcome your application. MAIN FUNCTION: The RN is a professional caregiver who assumes responsibility and accountability for… more
- Arnot Health (Elmira, NY)
- Job Description Up to a $25,000 Sign on Bonus for qualified Registered Nurses *Terms of payment may vary based on experience* Are you ready to join an organization ... and advancement opportunities. We welcome your application. MAIN FUNCTION: The RN is a professional caregiver who assumes responsibility and accountability for… more
- Glengariff Rehabilitation and Healthcare Center (Glen Cove, NY)
- …days a week 37.5 - 40 hours per week Respiratory Therapist (RT) / Respiratory Nurse ( RN ) We are searching for a highly motivated, flexible, organized, skilled ... meaningful contributions to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. +… more
- Northwell Health (Manhasset, NY)
- …five (5) years of job entry date. + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as ... + Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + Submits… more
- University of Rochester (Rochester, NY)
- …expertise of the individual, and internal equity considerations._ **Responsibilities:** The Utilization Management (UM) RN position spans the entire health ... majority of work is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent acute… more
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart review of ... certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis...policies and timelines + Adheres to CMS guidelines for utilization reviews as evidenced by utilization of… more
- Guthrie (Binghamton, NY)
- …care services regarding admissions, case management, discharge planning and utilization review. Responsibilites: Reviews admissions and service requests within ... needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally… more
- CVS Health (Albany, NY)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in clinically… more
- CVS Health (Albany, NY)
- …skills, both verbal and written. **Required Qualifications** + 2+ years of experience as a Registered Nurse + Must have active current and unrestricted RN ... is a full-time, telework role. Schedule is Monday through Friday, 8am-5pm EST. Utilization Management is a 24/7 operation and work schedules will include weekends,… more