- 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...federal regulations and all CMS activities. Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelors Degree in… more
- Nuvance Health (Carmel, NY)
- …in an acute care setting; Leadership experience preferred; Utilization review , discharge planning or case management experience preferred. Location: ... affiliates, Education: BSN / BSW preferred 1.Licensure/Registration/Certification:NYS Licensure as RN required; LMSW /LCSW preferred; Case management … more
- Mental Health Association in Ulster County, Inc. (Kingston, NY)
- …one year of employment* Overview MHA in Ulster County, Inc. seeks a Full-Time Registered Nurse to work in our Assertive Community Treatment Team (ACT Program) ... met. + Participate in ACT Treatment Team meetings, Incident Review meetings, Utilization Review meetings,...and Skills + A license to practice as a Registered Professional Nurse in New York State.… more
- MVP Health Care (Schenectady, NY)
- …in New York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required with at least 4 years of recent clinical and ... Care Management experience. + Certification in Case Manager (CCM) is...confidentiality. + Ability to make independent decisions regarding resource utilization , and quality of care. + Must demonstrate understanding… more
- Mount Sinai Health System (New York, NY)
- …Practitioner in New York State + Current license and registration as a Professional Registered Nurse in NY State (NP candidates) + National Board Certification ... **Job Description** **Job Title - Advanced Practitioner Provider Manager ( Nurse Practitioner/Physician Assistant) - Ambulatory Oncology - Mount Sinai Hospital-Full… more
- Trinity Health (Schenectady, NY)
- …clinical assessment **What you will need:** **Must have Active Licensure as a Registered Nurse , Occupational Therapist, or Physical Therapist** **A minimum of 2 ... members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources. + Screening of clients… more
- Evolent (Albany, NY)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases...patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care… more
- Evolent (Albany, NY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … 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
- Stony Brook University (Stony Brook, NY)
- …use of resources. + Oversee staff performance including new staff orientation + Knowledge of Utilization Review and LOS + Review of high-risk complex cases. ... as needed. **Preferred Qualifications:** + Master's Degree, + Certified RN , + CM Five years Case management ...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more