- Molina Healthcare (Syracuse, NY)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support... licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review… more
- Northwell Health (Sleepy Hollow, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives....entry date. + Current License to practice as a Registered Professional Nurse in New York State… more
- Molina Healthcare (Yonkers, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. MULTI… more
- Albany Medical Center (Albany, NY)
- …of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to… more
- Rochester Regional Health (Rochester, NY)
- …Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education ... Management Data base to support the clinical review process. + Concurrently monitors resources utilization ,...required + Licensed in New York State as a Registered Nurse + For hires after 10/28/2024,… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... navigation for patients, including triage management , algorithm management , utilization management and resource...possible after admission-within the first12 to 24 hours. Applies utilization review criteria to assess and document… more
- Nuvance Health (Poughkeepsie, NY)
- …or Certification Requirements:* * Current New York State a Registered Nurse license. * PREFER: QAPI certificate. Credentials: RN ,BLS Company: HQ Home ... *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi?...program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and… more
- Ellis Medicine (Schenectady, NY)
- …for appropriate Level of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional ... RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This...the Case Manager include, but are not limited to, utilization review , case management , care… more
- Bassett Healthcare (Cobleskill, NY)
- …needs. The RN contributes to the support of patients through interdisciplinary teamwork. + Registered Nurse I: The RN I status is only appropriate for a ... + Salary Range: $39.01 - $58.51 per hour + Registered Nurse II: The RN ...as measured by periodic random preceptor and supervisory chart review as per probationary appraisal schedule + ( RN… more
- Calvary Hospital (Bronx, NY)
- …and identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review , Discharge Planning, Risk Management , and Quality Assessment ... + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk...in nursing or health care related field preferred. + Registered professional nurse , currently unencumbered NYS licensure.… more