- Excellus BlueCross BlueShield (Rochester, NY)
- …development and promotional opportunities. All Levels + Associates degree and active NYS RN license required. Bachelors degree preferred. + Minimum of three years of ... expert for at least 5 years. + Broad understanding of multiple areas (ie UM and CM). Incumbent is required to know multiple functional areas and supporting systems.… more
- Molina Healthcare (Yonkers, NY)
- …acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must ... 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)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... purpose of reporting and implementing corrective measures. - Provide feedback to UM staff related to denial prevention strategies. - Participates in JCAHO hospital… more
- Centene Corporation (New York, NY)
- …and Certifications:** A license in one of the following is required: Licensed Registered Nurse ( RN ), Licensed Clinical Social Worker (LCSW), Licensed ... Clinical Social Work/Counseling required OR Associate's degree and an RN with 3+ years of clinical experience. 3+ years...or outpatient). 1+ year of experience in Managed Care ( UM , BH, CM) preferred. Familiarity with Medicare and Medicaid… more
- Independent Health (Buffalo, NY)
- …licensed professional counselor (LPC), licensed family or marriage therapist (LMFT) or active registered nurse ( RN ) in NYS required. Certified Case Manager ... inpatient BH treatment continuity. + Collaborate with other departments such as Medical UM , Medical Case Management, and SIU for specific BH related case review,… more
- Ellis Medicine (Schenectady, NY)
- …and assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, ... primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse ...insurance denials or quality improvement organization appeals. + Assists UM Coordinator with data entry of insurance authorizations and… more
- Elevance Health (Latham, NY)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... equivalent background. + Current active unrestricted license such as RN LCSW LMSW LMHC LPC LBA (as allowed by...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- Stony Brook University (Stony Brook, NY)
- …hospitalized patients who may be at a high risk for readmission. The RN following these patients must have good clinical and communication skills to address ... analysis * Adheres to all State and Federal requirements, RN license, JACHO, CMS and DOH regulations. * Maintain..._ _Bilingual_ _ * _ _Certified in Case Management, UM , Quality, Risk or MCG_ _ * _ _Home… 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 ... other functions as assigned by management. Minimum Qualifications: + RN with valid and current NYS Nursing Licensure. +...understanding of multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals/Grievances, within three… more
- Catholic Health Services (Melville, NY)
- …contractual changes from the Managed Care Department and applies to UM and appeals management processes. Works collaboratively with physicians, physician office ... Graduate of an accredited Nursing School or College; current New York State, RN License required, BSN Bachelor of Science in Nursing or Health preferred. Minimum… more