- Catholic Health Services (Port Jefferson, NY)
- …patients across the acute care continuum. + Perform required activities for utilization management , PRI assessment and completion, transition planning, and ... acute care clinical RN experience required + Prior RN experience in Utilization Management , Performance Improvement, Transition Planning and/or Care … more
- Trinity Health (Troy, NY)
- …Friday - Samaritan HospitalIf you are looking for a position in RN (Registered Nurse ) Case Management in a dynamic hospital, this could be your opportunity. ... **Description:** We at St. Peter's Health Partners recognize that nursing is one of the most challenging careers and...in acute settingPreferred requirements:1+ year of experience in case management or utilization managementCase Management … 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
- Crouse Hospital (Syracuse, NY)
- …of hospital resources while maintaining the quality of care. + Participates in the utilization management process using standards of care to determine the most ... Nurse (RN) license. + Graduate from an accredited nursing degree program required. + Bachelor of Science degree...- Five (5) years acute hospital experience. + Case Management or Utilization Management experience… more
- CenterWell (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... experience in a high volume and fast paced environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a related field… more
- Nuvance Health (Rhinebeck, 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
- Catholic Health Services (West Islip, NY)
- …hospital care management leadership role is required. + Experience in utilization management , working with managed care organizations, and discharge planning ... : + Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management , CH Utilization and Central Appeals, Managed Care and Revenue Cycle… more
- Molina Healthcare (Rochester, NY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical… more
- Cognizant (Albany, NY)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- New York State Civil Service (Albany, NY)
- …adolescents with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) ... will have direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of… more