- Crouse Hospital (Syracuse, NY)
- …and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse ( RN ) to track and manage data ... 8:00am-4:30pm, requires 6 weekends a year. Utilization Management Registered Nurse ( RN...the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent… more
- Humana (Albany, NY)
- …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review . + Minimum of two (2) years of proven experience in management or leadership… more
- CVS Health (NY)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review… more
- Guthrie (Binghamton, NY)
- Summary The Registered Nurse ( RN ) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician ... coding, medical record or chart auditing, and experience in utilization management processes preferred. Knowledge of computer...of patient status. 1. Collaborate and set standards with registered nurse ( RN ) case managers… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- CDPHP (Latham, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of… more
- Centene Corporation (New York, NY)
- …clinical license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them...beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary… more
- Catholic Health Services (Melville, NY)
- …from payors for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as ... care to MCC in response to physician order, or review of updated clinical information + Acts as a...current with industry standards and business objectives related to Utilization and Care Management as appropriate. +… more
- MVP Health Care (Tarrytown, NY)
- …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines ... To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join...interdisciplinary teams to ensure optimal patient care and resource utilization . + Document review outcomes and maintain… more
- Guthrie (Binghamton, NY)
- …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care...degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant… more