- CVS Health (Albany, NY)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... compliance driven timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and… more
- YesCare Corp (Coxsackie, NY)
- …measures including sentinel event review . + Actively participant of the Utilization Review process and follow proper procedures. + Provides appropriate ... Below is a list of your responsibilities as a ** Nurse Practitioner (NP/ARNP)** withYesCare: + **For this New York...in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as… more
- UHS (Johnson City, NY)
- Position OverviewPosition Summary: United Health Services is seeking a Nurse Manager to lead our Obstetrics Unit, overseeing daily clinical operations and staff ... collaborative environment for both patients and team members. The Nurse Manager provides direct supervision, facilitates evidence-based practice, and promotes… more
- Crouse Hospital (Syracuse, NY)
- …requirements related to acute care discharge planning + Preferred - Acute care utilization review experience Benefits Overview: + Medical, Dental, Vision, FSA, ... day management of the RN Care Managers in the department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing… more
- WellLife Network (South Richmond Hill, NY)
- …location and schedules are subject to change. + Attend certification inspections, utilization review and independent professional reviews as needed. + Attend ... Licensed Practical Nurse Relief -DDA106 - On-Call Job Details Job...medical pre-admission evaluations and screening of prospective clients. + Review and update persons with disabilities pre-admission evaluation within… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …(BHPS) provides Case Management services to its clients. Cases are maintained by the Nurse Case manager. The Nurse Case Manager reports to the Manager of ... for Case Management. * Determines appropriate care level and resource utilization for complex cases. * Facilitates discharge planning and evaluates alternative… more
- RiseBoro Homecare Inc. (Brooklyn, NY)
- ESSENTIAL DUTIES AND RESPONSIBILITIES The Registered Nurse will serve young adults and families with children headed by young adults ages 18 to 25 years old ... providing health care and management coordination. The Registered Nurse will: + Conduct assessment of the health needs...to clients as needed + Assist clients with medication review and understanding directives from Primary Care Physicians (PCPs)… more
- Crouse Hospital (Syracuse, NY)
- …Care Coordination Services team is hiring a Care Manager (in the NICU) to review the services delivered to patients and compare it to evidence-based guidelines in an ... maintaining the quality of care. + Participates in the utilization management process using standards of care to determine...Manager Position Requirements: + Must have a current Registered Nurse (RN) license. + Graduate from an accredited nursing… more
- Evolent (Albany, NY)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Elevance Health (Latham, NY)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more