- Insight Global (New York, NY)
- Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance ... Skills and Requirements - Reside in either TX, GA, FL, or AZ - Registered Nurse - Proficiency using a MacBook - Proficiency in Google Suite Applications (google… more
- CVS Health (NY)
- …Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Humana (Albany, NY)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Highmark Health (Albany, NY)
- …residency program + 5 - 7 years in Pharmacy + 3 - 5 years in Pharmacist - Utilization Management + 3 - 5 years in Pharmacist - Medical Therapy Management ... to medication therapy are transitioned to a Pharmacist for Case & Disease Management (CMDM). The incumbent then conducts thorough research to evaluate the patient… more
- Molina Healthcare (Rochester, NY)
- …and cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
- CenterWell (Albany, NY)
- …is an on** **‑** **site position located at our Bluffton, SC branch.** Remote , work-from-home, and hybrid work arrangements are not supported for this role.** The ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- CenterWell (Westbury, NY)
- …+ Valid driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home ... **Position Type** : On-site **Branch Location** : Westbury, NY **This is NOT a remote or work-from-home position. This position requires you to sit on-site at our… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. + Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... entry date. + Current License to practice as a Registered Professional Nurse in New York State required, plus...clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. +… more
- Albany Medical Center (Albany, NY)
- …short- and long-term goals and objectives. As a member of the nursing executive management team, the AVP participates in the efficient and effective management ... field. Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, involving… more
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