- 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 ... license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all… more
- CDPHP (Latham, 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
- 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 FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
- WMCHealth (Valhalla, NY)
- … Coordinator Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing / Nursing Management Department: Clinical Care Management ... the implementation or investigation of the procedures specified in the Quality Management , Utilization Review and Discharge Planning Program at Westchester… more
- Catholic Health Services (Melville, NY)
- …from payors for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as ... has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a...current with industry standards and business objectives related to Utilization and Care Management as appropriate. +… more
- Stony Brook University (Stony Brook, NY)
- …the following but are not limited to:** + Responsible for addressing Utilization management , denials and appeal, discharge and transition planning activities, ... Management leadership and staff functions regarding care management and utilization management activities....* Possession of license to practice as a registered nurse in New York State. * Master's degree with… more
- Guthrie (Binghamton, NY)
- …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... Arts (BA) degree in addition to a degree in Nursing . A registered nurse with five (5)...admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b.… more
- Kaleida Health (Buffalo, NY)
- …Business field preferred. RN licensure required.** **Experience** **10 years of care management / utilization management experience required in hospital and/or ... **VP Care Management Post-Acute Care Transition** **Location:** **Buffalo General Medical...**The Vice President (VP) role supports the system Chief Nurse Executive (CNE) in providing executive leadership and guidance… more
- Molina Healthcare (Syracuse, NY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member care management , and ... State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and evidence-based… more