- MVP Health Care (Rochester, NY)
- …York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required with at least 4 years of recent clinical and Care ... Management experience. + Certification in Case Manager (CCM) is...confidentiality. + Ability to make independent decisions regarding resource utilization , and quality of care. + Must demonstrate understanding… more
- Glens Falls Hospital (Glens Falls, NY)
- …least 30 hours per week, can be found*here*. **Job:** **Nursing - Case Management * **Title:** *Registered Nurse (RN) - Care Manager (GFMG) (Flexible Scheduling ... condition that may necessitate treatment change and will attend regular case review meetings. The Care Manager will work closely with the Interdisciplinary Team… more
- Fresenius Medical Center (Jamaica, NY)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Yonkers, NY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Nuvance Health (Carmel, NY)
- …in an acute care setting; Leadership experience preferred; Utilization review , discharge planning or case management experience preferred. Location: ... Carmel-PHC 670 Stoneleigh Avenue Work Type: Full-Time Standard Hours: 37.50 FTE: 1.000000 Work Schedule: Day 10 Work Shift: This is a Monday thru Friday position with rotating weekends. 8am-4pm Org Unit: 1168 Department: Care Coordination Exempt: Yes Grade:… more
- Humana (Albany, NY)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director… more
- Centene Corporation (New York, NY)
- …Knowledge of NCQA, 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
- Molina Healthcare (Yonkers, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Northwell Health (Staten Island, NY)
- …care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness ... + Current license to practice as a Registered Professional Nurse in New York State. + Case Management... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more
- Mount Sinai Health System (New York, NY)
- …to: a Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using standardized ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case Manager (CM) will...Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or… more