- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- Insight Global (New York, NY)
- Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more
- CenterWell (Albany, NY)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- CVS Health (NY)
- …work Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Molina Healthcare (Buffalo, NY)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title - Nurse Practitioner- ADS Telemetry - Mount Sinai Hospital - Full Time - Night** A nurse practitioner (NP) as described in Title ... clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for… more
- Northwell Health (Riverhead, NY)
- …to another level of care according to regulatory standards. + * Performs concurrent utilization management + Conducts chart review for appropriateness of ... + Current license to practice as a Registered Professional Nurse in New York State. + Minimum of one... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more
- Mount Sinai Health System (New York, NY)
- **Job Description** A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate ... clinical nursing education in a distinct specialty area of practice. Nurse practitioners are independent practitioners who diagnose, treat, and prescribe for… more
- Bassett Healthcare (Cobleskill, NY)
- …Schoharie County and the surrounding region What you'll do The Registered Professional Nurse (RN), Acute Care in the Medical Inpatient Unit is accountable for the ... needs. The RN contributes to the support of patients through interdisciplinary teamwork. + Registered Nurse I: The RN I status is only appropriate for a new nurse… more