- Molina Healthcare (NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- UHS (Norwich, NY)
- …Health Services (UHS) Chenango Memorial Hospital is seeking a compassionate and skilled Staff Registered Nurse ( RN ) or Graduate Nurse (GN) dedicated ... treatment. You will uphold all professional standards, including the New York State Nurse Practice Act and UHS policies, while fostering a caring and healing… more
- CenterWell (Albany, NY)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...on excellent service to others. **Required Qualifications** + Active RN license + Possession of or ability to obtain… more
- CenterWell (Albany, NY)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… 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… more
- Villa of Hope (Rochester, NY)
- …JOB SUMMARY: Under the general direction of the Nurse Manager, the Intake Coordinator- RN is a Registered Nurse who will assist in supervising Clinical ... director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and...or leaving against medical advice. MINIMUM QUALIFICATIONS: + NYS Registered Nurse license + Bachelor degree preferred… more
- Molina Healthcare (Yonkers, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Mount Sinai Health System (New York, NY)
- …Additional Detail** + Licensure: New York State License with current registration as a registered nurse . + State Certification: Certified by the New York State ... 6910 of the New York Education Law is a RN who has earned a separate certification as an...follows: a. Is a graduate of New York State registered Nurse Practitioner Program or equivalent OR… more
- Centene Corporation (New York, NY)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… 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 ... patients for follow-up by IP CM/SW Communicate any urgent needs to IP CM/SW Utilization Review : Complete admission review for medical necessity on… more