- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the ... Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior… more
- Evolent (Albany, NY)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical /Vocational Nurse with a current, ... the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks… more
- Guthrie (Binghamton, NY)
- …leadership and autonomy in nursing practice. + Preferred experience with care management / utilization review , and payer knowledge. + RN considered. ... accredited LPN program Licenses: + The Wellness Nurse must be licensed in both New...The applicant must have a current license as a Practical Nurse in their state of practice… more
- Centene Corporation (New York, NY)
- …preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure ... findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and… more
- Centene Corporation (New York, NY)
- …preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Datavant (Albany, NY)
- …it relates to job function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of...knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered… more
- DePaul (Rochester, NY)
- …+ Performs all other duties as assigned. Qualifications + Registered Nurse or Licensed Practical Nurse with 3 years of experience in long-term care; ... Management Plan within the corporation. + Incident Management - review incident reports and provide...reporting and follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual… more
- University of Rochester (Rochester, NY)
- …(RHIT) Program Preferred **_or_** + Licensure/credentials in clinical specialty such as Registered Nurse , Licensed Practical Nurse , or Emergency Medical ... requests, and external oversight: ie) NYS DOH, ACS Committee on Trauma Registry Management : + Monitor security of data to ensure the integrity and reliability of… more
- Elevance Health (Latham, NY)
- …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN /LVN ... The **Medical Management Clinician Associate** is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health, Quality Management , or Member ... and review timeliness, workflow volumes, referrals generated to care management programs + Provides administrative support to the grievance and appeals process… more