- Molina Healthcare (Albany, NY)
- …State Plan. **JOB QUALIFICATIONS** **Required Education** Any of the following: Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic… more
- Molina Healthcare (Yonkers, NY)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Bassett Healthcare (Cooperstown, NY)
- …a principle liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate bed ... IP CM/SW Communicate any urgent needs to IP CM/SW Utilization Review : Complete admission review ...and level of care matches order Collaborates with UM Nurse to assure that all payor and status requirements… more
- Trinity Health (Syracuse, NY)
- …is a key stakeholder in the emergency room care transition team which includes nurse case managers, utilization review nurses, providers, and etc. whom ... all work to ensure the best care possible both for patients who require acute care and those who do not but require connections and pathways to care to improve outcomes in a fast paced environment. **EDUCATION, TRAINING, EXPERIENCE, CERTIFICATION AND… more
- Northwell Health (Staten Island, NY)
- …case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. + Keeps ... concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness of admission and continued length of stay. + Contacts… more
- Molina Healthcare (Albany, NY)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Rochester Regional Health (Rochester, NY)
- …necessity in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay ... in the expected time frame and with most efficient utilization of resources. Carries out activities related to ...continuum. + Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based… more
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly...transition of care with Social Worker + Serves as nurse consultant for Social Worker cases with Clinical or… more
- Mount Sinai Health System (New York, NY)
- …**Experience Requirements** + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. ... are not limited to: a Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Mount Sinai Health System (New York, NY)
- …Masters preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... are not limited to: 1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more