- Molina Healthcare (Buffalo, NY)
- …(ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Molina Healthcare (Albany, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Molina Healthcare (Corona, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- Molina Healthcare (Buffalo, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support… more
- Molina Healthcare (East Syracuse, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job Summary The Care Review Clinician RN provides support for clinical member...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Rochester, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- Molina Healthcare (Bronx, NY)
- …and cost-effective member care. Essential Job Duties * Performs audits in utilization management , care management , member assessment, behavioral health, ... care experience, with at least 1 year experience in utilization management , care management , and/or...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Stony Brook University (Stony Brook, NY)
- … Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were… more
- Stony Brook University (Stony Brook, NY)
- …as a healthcare provider in the state of New York (eg, physician, nurse practitioner, or registered physician assistant or equivalent). Five (5) years of full ... developing educational materials, and implementing best practices to enhance EMR utilization . Through collaboration with the CRAFT team, the Director continuously… more
- Trinity Health (Syracuse, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management /Concurrent Review Nurse , physicians, staff and ... Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within… more
