- WMCHealth (Valhalla, NY)
- …two (2) years of Utilization Management or Appeal Management related experience Training/License: Current NYS RN license. Thorough knowledge of ... the results. + Maintains familiarity with the laws, regulations, and interpretation of utilization review and discharge planning. Remains up to date on changes… more
- Highmark Health (Albany, NY)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management ...in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or… more
- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director-Care Management Are you exceedingly driven, dedicated, and passionate...to be a St. Francis Hospital & Heart Center(R) RN . You are at the heart of health. St.… more
- Bassett Healthcare (Cooperstown, NY)
- …+ 1 year leadership experience, preferred Licensure/Certifications: + Current NYS Registered Professional Nurse license, required + Current BLS certification, ... others as appropriate to assess quality of care and review outcomes data and develop performance improvement plan when...or be suspended at any time. Bonus Amount: + RN (excluding management ) sign-on bonuses are awarded… more
- Access: Supports For Living (Middletown, NY)
- …leads and supports a Quality Team which is responsible for: Incident Management , Internal Regulatory Audits, Utilization Reviews and Quality Improvement ... all regulations, policies, protocols and procedures. + Assisting the Annual Program Review Meetings and updating and managing Billing Grids. + Developing and… more
- Catholic Health Services (Melville, NY)
- …members + Strong problem solving and investigative skills Essential Responsibilities (Project Management , Chart Review , Education) + Coordination with ProFee CDI ... The ProFee CDS will focus on pre-visit provider support, post-visit provider review , and collaboration and education with providers. Pre-visit provider support -… more
- Elevance Health (Latham, NY)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability utilization to ensure that clinic schedules ... eligibility. Applies scheduling priority guidelines, adheres to CC consult management timeliness metrics. Ensures designation of patient desired in-network community… more
- US Tech Solutions (Tarrytown, NY)
- …initiatives. - Lead material resource selection, standardization, price optimization and utilization initiatives while promoting and utilizing Value Analysis in the ... processes as it pertains to new product initiatives, category management strategies etc. . Lead the development and focus...in the development and ongoing improvement of new product review and approval process, and assist in identifying and… more
- Garnet Health (Harris, NY)
- …Manager for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. At Garnet Health, we are committed ... Medical Center - Catskills Emergency Department. Additionally will provide case management , and discharge planning for non-psychiatric patients. The Clinician is… more