- 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 ... Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Trinity Health (Syracuse, NY)
- …Day shifts. Emergency department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review (UR), Clinical Care Manger ... (CCM) actively manages the utilization review process and patient progression from...transition of care from admission to discharge. + Follows Medicare guidelines and industry standards to ensure the proper… more
- CenterWell (Albany, NY)
- …Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... 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… more
- CenterWell (Albany, NY)
- …or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... 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… more
- Centene Corporation (New York, NY)
- …including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- New York State Civil Service (Orangeburg, NY)
- …looking to hire a Registered Nurse 1, Psychiatric, to serve as a Utilization Review Coordinator (URC). Candidates from outside or within State Service can ... NY HELP Yes Agency Mental Health, Office of Title Registered Nurse 1 Psychiatric, (NY HELPS), Rockland Children's Psychiatric Center, P26613 Occupational Category… more
- Northern Rivers Family Services (Troy, NY)
- …county and community partners, and participate in any quality audit and utilization review + Provide on-site/community based/home visits, medication evaluations, ... Nurse Practitioner - Psychiatry Job Details Job Location...and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate… more
- Molina Healthcare (Albany, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… 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
- 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