- WellLife Network (South Richmond Hill, NY)
- …location and schedules are subject to change. 5. Attend certification inspections, utilization review and independent professional reviews as needed. 6. Attend ... medical pre-admission evaluations and screening of prospective clients. 2. Review and update persons with disabilities pre-admission evaluation within thirty… more
- Guthrie (Binghamton, NY)
- …Education: + Completion of an accredited LPN program Licenses: + The Wellness Nurse must be licensed in both New York and Pennsylvania. + The applicant ... autonomy in nursing practice. + Preferred experience with care management/ utilization review , and payer knowledge. + RN...must have a current license as a Practical Nurse in their state of practice… more
- CDPHP (Latham, NY)
- …clear understanding of prescription and medical benefits as it applies to the utilization review process. + Must demonstrate proficient experience with the ... be a part of that experience. Under the direct supervision of a licensed pharmacist, the Managed Care Pharmacy Technician (Pharmacy Tech) is responsible for… more
- DePaul (Rochester, NY)
- …+ Performs all other duties as assigned. Qualifications + Registered Nurse or Licensed Practical Nurse with 3 years of experience in long-term care; ... trends for reporting and follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual record audits,… more
- Elderwood (Waverly, NY)
- …Companies + Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review . Managed Care Coordinator Skills and Competencies + Demonstrated ... Overview Mon-Fri 8am-4pm The Managed Care Coordinator assists and supports the LPN /RN MDS Coordinator with case management responsibilities. The candidate is the… more
- Centene Corporation (New York, NY)
- …of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- University of Rochester (Rochester, NY)
- …(RHIT) Program Preferred **_or_** + Licensure/credentials in clinical specialty such as Registered Nurse , Licensed Practical Nurse , or Emergency Medical ... Attend registry vendor sponsored training workshops/meetings to maximize trauma registry utilization and performance. Registry Admin Duties + Oversee the conversion,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Specialist provides administrative support for any of the programs of Utilization Management, Behavioral Health, Quality Management, or Member Care Management. This ... to the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. +...for employee development and promotional opportunities. All Levels + LPN , Medical Assistant, Health Plan customer service or claims… more
- Nuvance Health (Poughkeepsie, NY)
- …to the position. * Performs patient care within the scope of practice as a Nurse (RN or LPN ), Respiratory Therapist, EMT, Paramedic. * Keeps complete and ... care to an assigned group of patients through the utilization Standards of Practice and policies and procedures and...in the respective field of qualifying credential (eg, Registered Nurse , LPN , Respiratory Therapist, EMT or Paramedic)… more
- Bassett Healthcare (Cooperstown, NY)
- …weekend and holiday coverage as well as weekday coverage. The Registered Professional Nurse Acute Care is accountable for the delivery of safe patient care utilizing ... and job description is only appropriate for a new nurse in the first year of practice, as support...than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. +… more