- 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 IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday -… more
- CVS Health (Albany, NY)
- …This is a full-time, telework role. Schedule is Monday through Friday, 8am-5pm EST. Utilization Management is a 24/7 operation and work schedules will include ... Qualifications** + 2+ years of experience as a Registered Nurse + Must have active current and unrestricted RN...or specialty area + Managed Care experience preferred, especially Utilization Management + Preference for those residing… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Albany, NY)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- CenterWell (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more
- Trinity Health (Troy, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and other ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified… more
- CDPHP (Albany, NY)
- …required as a Registered Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for...transportation, DME requests and inpatient readmissions. In collaboration with management , the UR nurse identifies potentially high-cost… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for… more
- CVS Health (Albany, NY)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Guidehouse (New York, NY)
- …nursing. + New York Nursing License - REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and InterQual guidelines + Ability to ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:**...certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis… more