- Evolent (Albany, NY)
- …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
- Molina Healthcare (Syracuse, NY)
- …be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- BronxCare Health System (Bronx, NY)
- …assist the department's leadership develop strategies for denial prevention, improved utilization management , documentation of medical necessity and identify ... avoidable day and barriers to discharge processes pertaining to utilization management . - Liaisons and coordinates with...On the job or formal training in certified case management , denial and appeals management … more
- Rochester Regional Health (Rochester, NY)
- …class as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on ... Job Title: Registered Nurse I Department: Utilization Management...UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an… 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 ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals… more
- Crouse Hospital (Syracuse, NY)
- … of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing workflow ... Manager who is responsible for providing day to day management of the RN Care Managers in the department....Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +… more
- Mount Sinai Health System (New York, NY)
- …are not limited to: a. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using ... **Job Description** **RN/Case Manager MSH Case Management PT Days** The Case Manager (CM) will...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Molina Healthcare (Rochester, NY)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Catholic Health (Buffalo, NY)
- …team with one of the major consultant firms + Proficiency in utilization management /clinical documentation Integrity and regulatory requirements required + ... + Ability to lead, challenge, motivate, coordinate and facilitate teams across the utilization management continuum + Understanding of clinical quality and … more
- Elevance Health (New York, NY)
- **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more