- Molina Healthcare (Syracuse, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… more
- Stony Brook University (Stony Brook, NY)
- …and other duties as required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license and working history ... RN Case Manager **Position Summary** At Stony Brook...their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge… more
- Trinity Health (Troy, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Supervisor for NEW ED Observation Unit at Samaritan Hospital** **Pavilion Building - ... 4T** **EXEMPT** **FT Days** If you are an experienced RN looking for a **_leadership_** position in the Observation/Clinical...M/S units. + Will work closely with Hospitalist and CM/ UM assigned to unit. **Functional Role (not inclusive of… more
- 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
- Centene Corporation (New York, NY)
- …of related experience. Knowledge of utilization management principles preferred. **License/Certification:** + RN - Registered Nurse - State Licensure and/or ... workplace flexibility. **Must have an active New York State RN license.** **Inpatient Utilization Management** **Position Purpose:** Supervises Prior Authorization,… more
- Datavant (Albany, NY)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… 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
- Evolent (Albany, NY)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... P2P discussions with one of the cardiologists. Responsible for coordinating with UM staff to ensure timely and accurate communication of clinical decisions.… more
- MVP Health Care (Rochester, NY)
- …York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 ... timely resolution. + Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines. + Contribute to our humble… more
- CDPHP (Latham, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory Therapist + Accepts responsibility for… more