- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... accredited Nursing School or College; current New York State, RN License required, BSN Bachelor of Science in Nursing...current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound… more
- Crouse Hospital (Syracuse, NY)
- …management of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing ... Manager who is responsible for providing day to day management of the RN Care Managers in...agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State +… more
- Catholic Health Services (Port Jefferson, NY)
- … 3+ Years acute care clinical RN experience required Prior RN experience in Utilization Management , Performance Improvement, Transition Planning ... across the acute care continuum. Perform required activities for utilization management , PRI assessment and completion, transition...in a BSN program may apply Licensure: New York Registered Nurse ( RN ) License &… more
- CVS Health (Albany, NY)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...in a hospital setting. + A Registered Nurse that holds an active, unrestricted… 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 ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Molina Healthcare (Syracuse, NY)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- Arnot Health (Elmira, NY)
- …of an approved registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three ... patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's average caseload will… more
- Stony Brook University (Stony Brook, NY)
- …including managing Case Management leadership and staff functions related to case management and utilization management activities. + Manage and mentor a ... design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead...degree. * Possession of license to practice as a registered nurse in New York State *… more
- Crouse Hospital (Syracuse, NY)
- …establish the plan of care. Care Manager Position Requirements: + Must have a current Registered Nurse ( RN ) license. + Graduate from an accredited nursing ... maintaining the quality of care. + Participates in the utilization management process using standards of care...YMCA Subsidy program. + Clinical Nursing Pathway Program for Registered Nurses designed to foster career growth and progression.… more
- Northwell Health (Staten Island, NY)
- …Nursing, required. + Current license to practice as a Registered Professional Nurse in New York State. + Case Management Certification, preferred. + Minimum ... another level of care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart review for… more