- Centene Corporation (New York, NY)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization... utilization management processes preferred.… more
- CDPHP (Latham, NY)
- …Programs RN Case Manager and the success of the member-focused Complex Case Management Programs. Qualifications: + Registered Nurse with a current New ... a part of that experience. The Medicaid Special Programs Registered Nurse Case Manager is responsible and...Care Programs preferred. + Minimum of two (2) years Utilization Management experience is preferred. + Experience… 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 ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- Catholic Health Services (Smithtown, NY)
- …patients across the acute care continuum. + Performs required activities for utilization management , PRI assessment and completion, transition planning, and ... clinical medical/surgical or specialty experience required. + 2-3 years' Utilization Management , Performance Improvement, Transition Planning and/or Care… more
- The New Jewish Home (Bronx, NY)
- …job functions.) Job Qualifications: + Current license and registration to practice as a Registered Nurse in New York State. + Bachelor's Degree in Nursing. + ... informed of the latest internal and external issues and trends in utilization and quality management through select committee participation, networking,… more
- Molina Healthcare (Buffalo, NY)
- …transitions, behavioral health, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), ... external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative...years in one or more of the following areas: utilization management , care management , care… more
- Molina Healthcare (Rochester, NY)
- …transitions, behavioral health, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ), Licensed Vocational Nurse (LVN), ... external vendors. * Focuses on process improvement, organizational change management , program management and other processes relative...years in one or more of the following areas: utilization management , care management , care… more
- MVP Health Care (Tarrytown, NY)
- …Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse ( RN ) required + New York State license required ... adolescents, with at least 2 years being ASD related + Utilization or Case Management experience in a managed care organization is preferred + Knowledgeable… more
- Elevance Health (Latham, NY)
- …providers, claims, or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic NICU Nurse Case Manager I** **Location: This role enables...a timely fashion. + Knowledge of health insurance/benefits, medical management process, care management , and utilization… more
- Mohawk Valley Health System (Utica, NY)
- …regulations. + Performs related duties as assigned. Education/Experience Requirements REQUIRED: + Registered Nurse licensed in State of New York, Bachelor's ... RN Supervisor Case Management - Full Time...and currently registered to practice as a Registered Nurse in New York State. Disclaimer Qualified… more