- CVS Health (Albany, NY)
- …all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- CVS Health (Albany, NY)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- CVS Health (Albany, NY)
- …(UM) Nurse Consultant . As a Utilization Management Nurse Consultant , you will utilize clinical skills to coordinate, document and communicate all ... clinical records. **Key Responsibilities of the UM Nurse Consultant ** (Includes but is not limited to) + Reviews...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Albany, NY)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in XXX zones **Education**… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... with active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications**… more
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** Dynamic and results-oriented Pharmacy Benefit Consultant , serving as the client-facing expert, driving growth and retention of ... Consultation: Provide in-depth pharmacy benefit expertise, offering strategic guidance, clinical recommendations, and solutions tailored to individual client needs.… more
- Mount Sinai Health System (New York, NY)
- …Patient screening 2) Patient/Family education 3) D/C planning and follow-up 4) Case management 5) Research d. Maintains clinical expertise in area of ... as a consultant by: Serves as a consultant by: 1) Assisting clinical nurses and...of nursing the application of theory and research in clinical practice. i. Participates in development and utilization… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …to its state licensure, third party administrators, utilization review and management requirements. The Manager of Compliance and Clinical Operations will ... maintenance of all HealthDirect policy and procedure. Responsible for the overall management of the clinical team and corresponding policy, procedure, and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …benefits and State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and ... area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member...at first level, appeal and inquiries. + Conducts peer-to-peer clinical reviews with attending physicians or other providers to… more
- Mount Sinai Health System (New York, NY)
- …CENP) or similar preferred Non-Bargaining Unit, 700 - Nursing Operations Management - MSH, Mount Sinai Hospital **Responsibilities** ** Clinical Leadership** ... Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators and… more
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