- Molina Healthcare (Syracuse, NY)
- …Utilization Review Lead responsibilities also include but not limited to, collaborate with UM Leadership to ensure the Daily Auth Reconciliation Report (DARR) is run ... **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Licensed Registered Nurse (RN), Licensed Vocational Nurse (LVN), or Licensed Practical… more
- Trinity Health (Troy, NY)
- …the ED pending bed availability on M/S units. Will work closely with Hospitalist and CM/ UM assigned to unit. Here at St. Peter's Health Partner's, we care for more ... evaluated + The RN is directly accountable to the Nurse Manager for the quality of patient care delivered...+ A current license to practice as a Registered Nurse in the State of New York + ASN… more
- Trinity Health (Troy, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Supervisor for NEW Observation Unit at Samaritan Hospital** **Pavilion Building - 4T** ... bed availability on M/S units. + Will work closely with Hospitalist and CM/ UM assigned to unit. **Functional Role (not inclusive of titles or advancement career… more
- Sharecare (Albany, NY)
- …hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision ... for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case management assistance +… more
- Molina Healthcare (Albany, NY)
- …Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Elevance Health (Latham, NY)
- …and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data entry of referral requests ... into the UM system in accordance with the plan certificate. + Responds to telephone and written inquiries from clients, providers and in-house departments. +… more
- Independent Health (Buffalo, NY)
- …counselor (LPC), licensed family or marriage therapist (LMFT) or active registered nurse (RN) in NYS required. Certified Case Manager (CCM) required. Candidates ... inpatient BH treatment continuity. + Collaborate with other departments such as Medical UM , Medical Case Management, and SIU for specific BH related case review,… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and ... + Case Management Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required to know multiple functional… more
- Molina Healthcare (Albany, NY)
- …appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership ... Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial… more
- Stony Brook University (Stony Brook, NY)
- …as required. **Qualifications** **Required** : Current NYS RN. A Bachelor's degree or a nurse working on their degree with an RN license and working history of 5 ... be able to prioritize their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge of MCG or Interqual… more