- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
- Rochester Regional Health (Rochester, NY)
- …member clinical education to Clinical Resource Nurse / Educator / Clinical Nurse Specialist * Completes performance appraisals for direct reports and assists ... Job Title: Assistant Nurse ManagerDepartment: Acute Stroke Location: RGH Hours Per...for a variety of nursing functions in support of management and staff. Serves as a resource for clinical… more
- Rochester Regional Health (Rochester, NY)
- …clinical education to Clinical Resource Nurse / Educator / Clinical Nurse Specialist *Completes performance appraisals for direct reports and assists Nurse ... Job Title: Assistant Nurse Manager Department: SSDU Location: RGH Hours Per...for a variety of nursing functions in support of management and staff. Serves as a resource for clinical… more
- Rochester Regional Health (Rochester, NY)
- …team member clinical education to Clinical Resource Nurse / Educator / Clinical Nurse Specialist *Serves as a clinical expert and is a member of the ... Job Title: Clinical Nurse Leader - Spencerport/Chili Dialysis Location: Split between...for a variety of nursing functions in support of management and staff. Serves as a resource for clinical… more
- Molina Healthcare (Albany, NY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Centene Corporation (Queens, NY)
- …medical abbreviations, medications. Experience in medical records review, claims processing or utilization and case management in a clinical practice or managed ... Long Term Care Department. Potentially working to review care management activities / records of the Care Management...or activities / clinical documentation submitted by the Intake Specialist . The Clinical Quality Assurance RN will review for… more
- WMCHealth (Suffern, NY)
- Registered Nurse Company: Good Samaritan Hospital City/State: Suffern, NY Category: Nursing/Nursing Management Department: Cath Suite Prep - Recovery Union: YES ... External Applicant link Internal Applicant link Job Details: The Registered Nurse (Cardiovascular Services) provides professional nursing care in Cardiac Suite, Cath… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... plus specialized certifications as needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management , and Clinical Appeals. 3-5 years of… more
- Northwell Health (Manhasset, NY)
- …team and provide pharmacy recommendations + Education and development of nurse , physician and pharmacy staff development pertaining to transplant and ... and research. + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy, and… more
- Highmark Health (Buffalo, NY)
- …result in the greatest ROI for the Organization. Further, in a matrix management environment, will be responsible for collaborative work with the other members of ... and interpretation of claims submission for superior coding accuracy, cost and utilization reports, medical loss ratio reports, Medicare STARS gaps and other risk… more