- Constructive Partnerships Unlimited (Brooklyn, NY)
- …and Nurse Administrators, works collaboratively and assists in the management of medical care for all individuals served and maintaining appropriate ... various source documents into the computer system for storage, processing and data management purposes. Shift Worked: 9:00 AM-5:00 PM Weekly Hours: 37.5 FLSA Status:… more
- Catholic Health Services (West Islip, NY)
- …+ Ensures compliance with Hospital Conditions of Participation. + Implements care management programs, including utilization review , intake and discharge ... hospital care management leadership role is required. + Experience in utilization management , working with managed care organizations, and discharge planning… more
- Highmark Health (Albany, NY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Bassett Healthcare (Cooperstown, NY)
- …exceptions, as measured by direct supervisory observation and random supervisory chart review + Demonstrates consideration of safety, effective utilization of ... quality of life possible. What you'll do The STAT Nurse RN will provide clinical support and direct patient...than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback +… more
- MVP Health Care (Schenectady, NY)
- …Workplace** . The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. ... health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse (RN) required + New York State license required...with at least 2 years being ASD related + Utilization or Case Management experience in a… 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
- MVP Health Care (Schenectady, NY)
- …every interaction **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes ... **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months… more
- University of Rochester (Rochester, NY)
- …Serves as the primary internal contact for national and state registry data management questions, issues or concerns, but not limited to clinical data collection, ... validation, delivery, reconciliation, and data management activity timeliness. Concurrently and retrospectively reviews medical records and data to identify patient… more
- Albany Medical Center (Albany, NY)
- …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, involving… more
- Datavant (Albany, NY)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +...management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more