- Baylor Scott & White Health (Albany, NY)
- …priority. Note: Benefits may vary based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for ... provider's care coordination departments. Your expertise is needed to review medical necessity. Working with the team, you'll verify...experience is required. + You must hold a valid Registered Nurse License ( RN ). As… more
- University of Rochester (Rochester, NY)
- …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
- CVS Health (Albany, NY)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... remote role open to candidates with an active RN licensure in the state in which they reside....to promote quality effectiveness of healthcare services and benefit utilization . **Required Qualifications** + Active and unrestricted RN… more
- Highmark Health (Albany, NY)
- …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- CenterWell (Westbury, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (NY)
- **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support,… more
- Guthrie (Corning, NY)
- …data analysis and process outcome evaluation. Education, License & Cert: Licensed Registered Nurse . Bachelor's Degree in Nursing or related field required. ... applicant must have a current license as a Professional Registered Nurse in their state of practice...in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... of consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and… more
- Sharecare (Albany, NY)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
- Centene Corporation (New York, NY)
- …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more