- Cognizant (Albany, NY)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Molina Healthcare (NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** The Care Review Clinician ( RN ) provides support for...Further details to be discussed during our interview process. Remote - requires RN license Work schedule: Saturday… more
- Molina Healthcare (Syracuse, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...Friday 8:00am- 5:pm with rotational weekend and holiday coverage Remote position MA RN licensure required **Essential… more
- Centene Corporation (New York, NY)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required Pay Range: $26.50 - $47.59 per hour… more
- Centene Corporation (New York, NY)
- …related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... on workplace flexibility. **Must have an active New York State RN license.** **Inpatient Utilization Management** **Position Purpose:** Supervises Prior… more
- Molina Healthcare (NY)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review ... 8 AM to 5 PM EST This is a Remote position, home office with internet connectivity of high...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Buffalo, 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 Clinical Appeals Nurse ( RN ) provides support for internal...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Molina Healthcare (Buffalo, NY)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...clinical nursing experience, including at least 1 year of utilization review , medical claims review ,… more
- Molina Healthcare (NY)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more