- Catholic Health Services (Smithtown, NY)
- …for patients across the acute care continuum. Performs required activities for utilization management , PRI assessment and completion, transition planning, and ... relevant clinical medical/surgical or specialty experience required. 2-3 years' Utilization Management , Performance Improvement, Transition Planning and/or Care… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … management rounds. + Provision of clinical oversight and leadership to Utilization Management /Case Management (UM/CM) staff working with the children's ... in timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers...Develops and implements the BH sections of the Quality Management / Utilization Management (QM/UM) Plan, including… more
- Elderwood (Lake Placid, NY)
- …compliance with Federal, State, and facility policies + Actively participate in utilization management processes, including PDPM and state case mix systems ... $74,000 to $96,525 / year Overview RN - MDS Nurse Assessor Pay Rate Range:$74,000 - $96,525 / year...for Full-time and Part-time positions Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself… more
- Stony Brook University (Stony Brook, NY)
- …telephonically post-discharge and assist with barriers to care * Prior experience with Care Management or Utilization Management * Understand levels of care ... quality multidisciplinary care is provided to the patients. * Documents the case management plans such as clinical needs, barriers, utilization of resources via… more
- Elevance Health (Latham, NY)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- CDPHP (Albany, NY)
- …valid NYS registration or license required. + Minimum two (2) years of utilization management concepts and techniques within an HMO, Managed Care Organization, ... new and emerging technologies and interfacing with the medical directors, utilization review staff, and other key policy stakeholders Qualifications: + Bachelor's… more
- Elevance Health (Latham, NY)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... ** Nurse Case Manager II** **Location:** This role enables... Case Manager II** will be responsible for care management within the scope of licensure for members with… more
- Molina Healthcare (Yonkers, NY)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- University of Rochester (Brighton, NY)
- …results received and acted upon as needed + Document plan of care, patient utilization , care management activities and other required information in state and ... and internal equity considerations._ **Responsibilities:** Provides professional comprehensive care management services to patients of the Strong Memorial Hospital,… more
- Molina Healthcare (Buffalo, NY)
- …including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management ... work of external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative to the business.… more