- CVS Health (Albany, NY)
- …high-quality healthcare for members. We are seeking a dedicated Utilization Management ( UM ) Nurse Consultant to join our remote team. **Key Responsibilities** ... of a computer. + Flexibility to provide coverage for other Utilization Management ( UM ) Nurses across various UM specialty teams as needed, ensuring continuity… more
- Mount Sinai Health System (New York, NY)
- …to appropriate departments + Monitors Concurrent Nurse denial phone calls for UM Nurse to follow + Prioritizes work as per department protocol (IPRO ... Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in Allscripts + Meets...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials +… more
- Molina Healthcare (NY)
- …this position we are hiring for a float team to support PEGA UM systems throughout multiple states.** **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services ... Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... required. + Broad understanding of multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals/Grievances, within three months of working in… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex ... of clinical oversight and leadership to Utilization Management/Case Management ( UM /CM) staff working with the children's population. + Develops, implements,… more
- Humana (Albany, NY)
- …+ Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and facilitating NCQA UM ... Health; MED-Deeming accreditation standards knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care, Medicaid health… more
- Molina Healthcare (Syracuse, NY)
- …or a compact licensure. The ideal candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates ... Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
- BronxCare Health System (Bronx, NY)
- …purpose of reporting and implementing corrective measures. - Provide feedback to UM staff related to denial prevention strategies. - Participates in JCAHO hospital ... basis and reports findings/analysis to Director. - Conducts educational/feedback sessions with UM staff related to PI activity findings and need for corrective… more
- Molina Healthcare (Buffalo, NY)
- …with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. **JOB QUALIFICATIONS** **Required Education** Any of the ... following: Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a bachelor's or master's degree in a… more
- Ellis Medicine (Schenectady, NY)
- …The Discharge Planner's primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge ... in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, updating… more