- 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
- Mohawk Valley Health System (Utica, NY)
- …+ 8 years of clinical experience. Previous or current experience working in Quality Management / Utilization Management field. + 5 years of management ... Sr Director Quality Management & Regulatory Affairs - Full Time -...working collaboratively across organizational lines to facilitate hospital and nursing operations and ensure patient needs are met. +… more
- Rochester Regional Health (Rochester, NY)
- …case coordination/patient navigation for patients, including triage management , algorithm management , utilization management and resource management . ... Job Title: Nurse Navigator - Heart Failure Clinic Location: Rochester...with continually improving the quality and effectiveness of case management /patient navigation. RESPONSIBILITIES + Reviews the medical record with… more
- Mohawk Valley Health System (Utica, NY)
- …+ 3 years of clinical experience. + Strong computer skills. PREFERRED: + Case Management , Utilization Management and Quality Management experience ... Transitional Care RN - Case Management - Full Time - Days Department: CASE...+ Coordinate processes designed to reduce readmissions with physicians, nursing staff, the patient and care givers. + Implement… 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
- Nuvance Health (Poughkeepsie, NY)
- …case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within ... affiliates, Position Summary: Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support… more
- Mount Sinai Health System (New York, NY)
- …NYSNA-SLW NYSNA at Mount Sinai St. Luke's and Mount Sinai West, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** 1. Principle Duties and ... are not limited to: 1. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using… more
- Evolent (Albany, NY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Molina Healthcare (NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- CVS Health (Albany, NY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more