- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review / Management .Company: Vassar Brothers Medical Center Org Unit: ... case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within… more
- CVS Health (Albany, NY)
- …You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With ... exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… more
- Evolent (Albany, NY)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Case Management . * Determines appropriate care level and resource utilization for complex cases. * Facilitates discharge planning and evaluates alternative ... The Role Brighton Health Plan Solutions (BHPS) provides Case Management services to its clients. Cases are maintained by...services to its clients. Cases are maintained by the Nurse Case manager. The Nurse Case Manager… 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
- 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 ... is hiring a Care Manager (in the NICU) to review the services delivered to patients and compare it...years acute hospital experience. + NICU experience + Case Management or Utilization Management experience… more
- RiseBoro Homecare Inc. (Brooklyn, NY)
- …headed by young adults ages 18 to 25 years old providing health care and management coordination. The Registered Nurse will: + Conduct assessment of the health ... ESSENTIAL DUTIES AND RESPONSIBILITIES The Registered Nurse will serve young adults and families with...to clients as needed + Assist clients with medication review and understanding directives from Primary Care Physicians (PCPs)… more
- Evolent (Albany, NY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … 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