- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Agency/Dept.: Monroe Community Hospital Description of Duties This position is in the Utilization Review Unit and functions as an assessment nurse. This is a… more
- Centene Corporation (New York, NY)
- …discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families ... regrading BH utilization process + Interacts with BH healthcare providers as...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Guthrie (Binghamton, NY)
- …care services regarding admissions, case management, discharge planning and utilization review. Responsibilites: Reviews admissions and service requests within ... needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …and goal of sustaining high quality care/service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as needed ... with assuring compliance with external and internal utilization review/quality and appropriateness requirements. What qualifications do you need: + Bachelor degree… more
- MVP Health Care (Tarrytown, NY)
- …To achieve this, we're looking for a **Medical Director, Post-Acute Care Utilization Management** to join #TeamMVP. If you have a passion for collaboration ... continued stay requests, and handling first-level appeals. + Collaborate with Utilization Management, Case Management, Quality Department and other areas of the… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services ... is required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is preferred. +… more
- CenterWell (Albany, NY)
- …Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all ... determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and… more