- Mount Sinai Health System (Long Island City, NY)
- …Description** The Director will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate ... **Education Requirements** Bachelor of Science with a major in nursing Master?s degree in nursing or healthcare-related...or healthcare-related field **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse … more
- Molina Healthcare (Buffalo, NY)
- …State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality ... management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages with… more
- Catholic Health Services (Melville, NY)
- …Physician Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management (UM) committees. Supervises the Facility Physician ... Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices… more
- Kaleida Health (Buffalo, NY)
- …and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the ... Director, Clinical & DRG Denials will work collaboratively with physicians, nursing staff, Quality, Finance and others to develop, implement and maintain… more
- Veterans Affairs, Veterans Health Administration (Syracuse, NY)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an… more
- Northwell Health (Staten Island, NY)
- …+ Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria + ... **Req Number** 162425 Registered Nurse Case Manager - FlexStaff Serves as liaison...Submits data to management regarding case management and/or quality initiatives… more
- Northwell Health (Manhasset, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives....Job Qualification + Graduate from an accredited School of Nursing . Bachelor's Degree in Nursing , preferred. Must… more
- Highmark Health (Albany, NY)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and… more
- Healthfirst (NY)
- …+ BA or BSN + Relevant clinical experience such as previous care or utilization management , home care, or geriatrics + Knowledge of Department of Health ... least one year is in the following areas: Geriatrics, Home Care, Discharge Planning, Case Management or Medical Surgical Nursing . **Preferred Qualifications:**… more
- Catholic Health (Buffalo, NY)
- …a registered nurse required + One year previous case, disease, or utilization management experience preferred + One year previous experience in a physician ... illness, improve compliance with evidence based clinical guidelines, encourage patient self- management , increase coordination of care, increase the utilization … more