- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse ( RN ) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse ( ... Duties This position is in the Utilization Review Unit and functions as an assessment nurse...Qualifications Possession of a New York State License as a Registered Nurse . Download/View Full Announcement Apply… more
- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... state of New York.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a...beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary… more
- Guthrie (Binghamton, NY)
- …health care services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review ... care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization ...- Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - ... with minimum direction. + Act as a resource for utilization review stakeholders and assists team members...on health system needs + Current New York State Registered Nurse License PREFERRED QUALIFICATIONS: +… more
- Guidehouse (New York, NY)
- …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:**...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
- University of Rochester (Rochester, NY)
- …The majority of work is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent ... of the individual, and internal equity considerations._ **Responsibilities:** The Utilization Management (UM) RN position spans the...Social Work, Patients, and various insurance companies. The UM RN is responsible for the review of… more
- Molina Healthcare (Syracuse, NY)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... leadership skills. **Required License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) in good standing. + MULTI STATE… more
- Molina Healthcare (Buffalo, 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