- Molina Healthcare (Bronx, NY)
- …cost-effective member care. Essential Job Duties * Performs audits in utilization management, care management, member assessment, behavioral health, and/or other ... clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance,...care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent… more
- Datavant (Albany, NY)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
- UHS (Vestal, NY)
- …the highest standards of patient care through effective resource coordination and utilization . In this role, you'll collaborate with clinical teams to manage ... Management, Risk Management, Performance Improvement, and other system members to review , implement, and monitor regulatory requirements from CMS, Joint Commission,… more
- The New Jewish Home (Bronx, NY)
- …infection control policies and procedures. o Monitors quality of care delivered by staff through record review , conferences, supervisory visits and review ... operations, performance improvement activities, training and supervision of nursing and field staff and medical compliance issues. Reports To: AVP, Home & Community… more
- Calvary Hospital (Bronx, NY)
- …pertinent data. 8. Knowledge of and experience in Quality Assessment and Improvement, Utilization Review . 9. Ability to develop management systems to track data ... has been denied. Conducts interdepartmental meetings related to the quality and utilization of clinical services. Serves on various Hospital committees as assigned.… more
- Guthrie (Binghamton, NY)
- …leadership and autonomy in nursing practice. + Preferred experience with care management/ utilization review , and payer knowledge. + RN considered. Education: + ... to a $15,000.00 Sign on Bonus!! Summary: The Wellness Nurse plays a key role in health promotion and...areas and at all levels of Guthrie, you'll find staff members who have committed themselves to serving the… more
- Albany Medical Center (Albany, NY)
- …of America) Salary Range: $83,200.00 - $128,960.00 Salary range: $33/hr. - $47.60/hr. Registered Nurse (RN) - Full TimeHIV Medicine Clinic - Albany, NY We have an ... advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN),...an open and appropriate manner with patients, visitors and staff * Participates in in-office procedures under the direction and… more
- Veterans Affairs, Veterans Health Administration (Riverhead, NY)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... coordinated care delivery model. Coordinates] with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic [schedules… more
- MVP Health Care (Rochester, NY)
- …you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after ... **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning,… more
- Arnot Health (Elmira, NY)
- …related to the management of patient care . The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... cost , patient outcomes. The Case Manager works collaboratively with interdisciplinary staff internal and external to the organization. The Case Manager participates… more