- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
- Molina Healthcare (Rochester, 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
- Highmark Health (Albany, NY)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Mental Health Association in Ulster County, Inc. (Kingston, NY)
- …and billing needs are met. + Participate in ACT Treatment Team meetings, Incident Review meetings, Utilization Review meetings, Treatment Plan Review ... MHA in Ulster County, Inc. seeks a Full-Time Registered Nurse to work in our Assertive Community Treatment Team...ACT Program. Make all necessary medical referrals. + Provide management and administration of medication in conjunction with the… 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 ... Coordination Services team is hiring a Care Manager to review the services delivered to patients and compare it...- Five (5) years acute hospital experience. + Case Management or Utilization Management experience… more
- Rochester Regional Health (Rochester, NY)
- …+ Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. + ... Job Title: Registered Nurse Case Manager IIDepartment: Home Care Location: West...required. + Performs other job-related duties as assigned by management . LEVEL II: + Offers process improvement suggestions and… more
- Project Renewal, Inc. (New York, NY)
- …programs + Participates in the development and implementation of quality assurance management and utilization review + Participates in interdisciplinary ... Title: Primary Care Nurse Practitioner - Part Time Program: Healthcare Department...$87,000 depending on experience Position Overview: The Primary Care Nurse Practitioner working in Mobile Health is responsible for… more
- Wellpath (Valhalla, NY)
- …care through adherence to policies and procedures for admission and transfer, utilization review , and referrals. + Assumes responsibility and accountability for ... of care support. **How you make a difference** The Psychiatric Nurse Practitioner(Psych NP)follows established policies and procedures and state guidelines, ensuring… more
- Rochester Regional Health (Rochester, NY)
- …the quality of care. ATTRIBUTES + Three (3) years of acute hospital care, case management or utilization management experience preferred + Excellent oral and ... a holiday every other year. Sign-On Bonus: Yes SUMMARY:As a Registered Nurse - Care Manager, your excellent interpersonal, leadership and collaboration skills ensure… more
- Molina Healthcare (Albany, 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