- Guthrie (Binghamton, NY)
- …(5) years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtain ... a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or BA degree… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision… more
- Molina Healthcare (Syracuse, NY)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- Sedgwick (Albany, NY)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- University of Rochester (Rochester, NY)
- …application of strict inclusion/exclusion criteria and protocols. Performs meticulous chart review and enters clinical data into the quality databases to identify ... for improved outcomes, reduced cost, improved LOS, and best practice utilization of resources. Performs complete and accurate collection of preoperative, operative,… more
- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- Summary The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization Statistical ... care delivery model. - Coordinates with the patient care team to review clinic appointment availability/ utilization to ensure that clinic schedules are… more
- Mount Sinai Health System (New York, NY)
- …in the Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators ... **Job Description** The Director of Nursing Professional Practice is a professional nurse with broad knowledge and skill in the professional practice standards, NYS… more
- Nuvance Health (Poughkeepsie, NY)
- …management of patient care to an assigned group of patients through the utilization Standards of Practice and policies and procedures and in collaboration with other ... patient care within the scope of practice as a Nurse (RN or LPN), Respiratory Therapist, EMT, Paramedic. *...forces as requested. * Participates in the discussion and review of articles in the field of hyperbaric oxygen.… more
- Kaleida Health (Williamsville, NY)
- …2 years of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interqual Criteria set ... with members of the interdisciplinary team to coordinate care, facilitate utilization and resource management and discharge planning functions, working to achieve… more