- 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
- Cognizant (Albany, NY)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... in health care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… 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
- New York State Civil Service (Malone, NY)
- …and Community Supervision, Department of Title Registered Nurse 3 - Utilization Temp/Hourly Occupational Category Health Care, Human/Social Services Salary Grade NS ... of post-licensure clinical nursing experience of which one year was in utilization review and/or discharge planning.Substitution: a bachelor's degree in nursing can… 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
- CVS Health (Albany, NY)
- …heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. The ... with active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications** +… more
- Humana (Albany, NY)
- …first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical information ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
- CDPHP (Latham, 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
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