- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - ... Agency/Dept.: Monroe Community Hospital Description of Duties This position is in the Utilization Review Unit and functions as an assessment nurse . This is a… more
- Trinity Health (Troy, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse , physicians, staff and ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified… more
- New York State Civil Service (New York, NY)
- …Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 Occupational Category Health Care, Human/Social Services ... York State NY Zip Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily … 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
- WMCHealth (Valhalla, NY)
- …implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical ... York State Department of Education, as a registered professional nurse . Training and Experience: three years of experience where...of which must have been in the area of utilization review , quality assurance, risk management or… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
- Elevance Health (Middletown, NY)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location:** Virtual: This role...responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more