- Guidehouse (New York, NY)
- …nursing. + New York Nursing License - REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and InterQual guidelines + Ability to ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:**...certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis… more
- BriteLife Recovery (Englewood, NJ)
- …compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials, approvals, ... you? + Minimum of 2-3 years of experience in utilization review, case management , or insurance coordination...a related field required; advanced degree or licensure (eg, RN , LCSW, LPC, LMHC, or CADC) preferred. + Excellent… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for… more
- Northwell Health (New York, NY)
- …or throughout the entire continuum of health care delivery. Performs resource management , utilization management , discharge planning, care facilitation, ... defined patient population, and as it relates to care management and the delivery of patient care services. Communicates...Degree, preferred. + Current license to practice as a Registered Professional Nurse in New York State.… more
- CVS Health (North Bergen, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management ,… more
- Molina Healthcare (Yonkers, NY)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- CVS Health (Englewood, NJ)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... responsible for; care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong...home health or ambulatory care + Active and Unrestricted RN license in NJ + 50 to 75% travel… more
- CVS Health (West New York, NJ)
- …new hires upon achieving proficiency in the role. **Required Qualifications** + Active, unrestricted ** Registered Nurse ( RN ) license in New Jersey** . + ... high-quality, cost-effective care for our members. These strategies encompass utilization management , quality improvement, network coordination, and clinical… more
- CVS Health (Passaic, NJ)
- …Choice Certification = $10,000_** + **_External Hire = $7500_** **Position Summary: Case Manager Registered Nurse - Field in Passaic County, NJ** This is a ... the development and implementation of health service strategies. This includes utilization management , quality improvement, and coordination of physical,… more
- Northwell Health (Manhasset, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives....entry date. + Current License to practice as a Registered Professional Nurse in New York State… more
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