- Highmark Health (Albany, NY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Centene Corporation (New York, NY)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Centene Corporation (New York, NY)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- University of Rochester (Albany, NY)
- …Oversees and directs unit activities including standards development, human resource management , assessment of resource needs and utilization , staff development ... to all and is a place where all can thrive. **Job Location (Full Address):** Remote Work - New York, Albany, New York, United States of America, 12224 **Opening:**… more
- Molina Healthcare (Albany, NY)
- …and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At… more
- Molina Healthcare (Rochester, NY)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... work of external vendors. * Focuses on process improvement, organizational change management , program management and other processes relative to business needs.… more
- Molina Healthcare (Rochester, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... environment. Further details to be discussed during our interview process. Remote - requires RN license Work schedule: Saturday 8:am-12:00pm, Monday- Friday: 8:00am-… more
- CenterWell (Westbury, NY)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home health, ... **Position Type** : On-site **Branch Location** : Westbury, NY **This is not a remote or work-from-home position. This position requires you to sit on-site at our… more
- Albany Medical Center (Albany, NY)
- …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, involving… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more