- Northwell Health (Staten Island, NY)
- …in case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. ... concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness of admission and continued length of stay. + Contacts… more
- Albany Medical Center (Albany, NY)
- …stays, and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- Humana (Albany, NY)
- …of MHK + Previous Medicare/Medicaid Experience + Previous experience in utilization management + Previous claims experience **Work-At- Home Requirements** To ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Albany, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... help us put health first** Reports To: Associate Director, Home Health Branch Administrator FLSA: Exempt **Work Schedule** :...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Whitney Young Health Center (Albany, NY)
- …timely completion of Specialty HARPS Assessments for all participants + Performs utilization review and chart audits necessary to ensure accurate/complete ... Health Home Program Manager - ADULT/HARPS (Req 101037) Albany,...Managed Care Organizations (MCO) regarding high risk, high service utilization for ADULT/HARPS. + Submits monthly reporting and documentation… more
- Mohawk Valley Health System (Utica, NY)
- …scheduling records. + Participates in agency meetings and the quality improvement and utilization review activities of the organization. + Follows all state, ... Home Health Scheduler - Full Time - Days...Participates in agency meetings and the quality improvement and utilization review activities of the organization. +… 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 Monroe Hours Per Week:...Manages more complex assignments and larger caseloads with appropriate utilization of services. REQUIRED QUALIFICATIONS: + Level I -… more
- Molina Healthcare (Buffalo, NY)
- …current active license for state of KY and or compact licensure The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and ... required (Saturday, Sunday (either one or both)) This is a Remote position, home office with internet connectivity of high speed required. Job Summary Provides… more
- Molina Healthcare (Albany, NY)
- …Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high speed required Work Schedule Monday to ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
Recent Jobs
-
CFO Advisory, Accounting Advisory Senior Manager
- Cherry Bekaert (Chicago, IL)
-
Principal Network Security Engineer
- Palo Alto Networks (Santa Clara, CA)
-
Grill Cook (Full Time)
- Compass Group, North America (Crete, NE)