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Utilization Review Nurse Jobs in New York City, New York

611 jobs

Overview: The purpose of this position is to ensure that Archcare Advantage members obtain timely, cost-effective, quality care in the appropriate setting. The primary role of the Utilization Review (UR) Nurse is to provide clinical support to the Clinical Services Department and Medical Director to assure that our members receive all appropriate medical services in compliance with medical and re...

Patient Utilization Review Nurse Description: “Engaging Talent for Extraordinary Careers” You may knowMt. Sinai Health Systemby our hospitals.BethIsraelMedicalCenter, Beth Israel Hospital/Brooklyn, Mt. Sinai Hosptal, Mt. Sinai Hospital /Queens,St. Luke’s-Roosevelt Hospitals, and New York Eye and Ear Infirmary are some ofNew York City’s most distinguished health care providers.Mt. Sinai Health S...

SMQT Certified RN wanted for 3rd quarter project! Adult Care, Nursing Homes, Home Care, and Immediate Care experience all needed. Apply today for immediate consideration. Utilization review nurses assist in reviewing patient services in regards to medical necessity and the appropriate use of resources. As a critical member of the hospital staff, the utilization review nurse is also responsible fo...

Description: Our Case Managers, play an essential role in the patient experience by serving as the liaison between the patient and the facility/physician. In this role, you will facilitate the patient's hospitalization from pre-admission through post-discharge. You will coordinate with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effecti...

Job Description:Job Type: * Full Time Registered Nurse: Full Time: Monday-Friday: 8A-5P. Casual opportunities also available. Three to five years clinical experience. RN. BSN preferred. Licensed in the State of Delaware , RN. Must be proficient in word processing and the use of clinical software. Previous experience in Case Management including knowledge of Interqual criteria and Utilization Manag...

(adsbygoogle = window.adsbygoogle []).push({}); ANNOUNCEMENT OF ProfessionalVacancySTATE UNIVERSITY OF NEW YORK· DOWNSTATE MEDICAL CENTER 450 CLARKSON AVENUE, BOX 1194, BROOKLYN, NEW YORK11203Department: CARE MANAGEMENT Job Title: TH Utilization Review & Quality Assuace SProfessional Rank: SL-4 Descriptive Title: TH Utilization Review & Quality Assurance Senior Coordinator (Part-Time)Salary Ra...

The Utilization Review Clinician performs utilization review and initial authorization determination of mental health and substance use services provided in inpatient, diversionary and outpatient care settings. She/he applies Beacon’s medical necessity level of care criteria and ensures that all Beacon policy and procedure guidelines, external regulatory requirements and URAC/NCQA accreditation st...

POSITION DESCRIPTION TITLE: Utilization Review Specialist REPORTS TO: Psychiatrist and VP Practice Management LOCATION: Bronx DEPARTMENT: Mental Health POSITION STATUS: Full-Time FLSA STATUS: Non - Exempt SUMMARY OF POSITION: The Utilization review specialist is essential to the Brightpoint Health Counseling Center’s operations. This position will review selected patients against the admissio...

POSITION DESCRIPTION TITLE: Utilization Review Specialist REPORTS TO: Psychiatrist and VP Practice Management LOCATION: Bronx DEPARTMENT: Mental Health POSITION STATUS: Full-Time FLSA STATUS: Non - Exempt SUMMARY OF POSITION: The Utilization review specialist is essential to the Brightpoint Health Counseling Center’s operations. This position will review selected patients against the admissio...

POSITION DESCRIPTION TITLE: Utilization Review Specialist REPORTS TO: Psychiatrist and VP Practice Management LOCATION: Bronx DEPARTMENT: Mental Health POSITION STATUS: Full-Time FLSA STATUS: Non - Exempt SUMMARY OF POSITION: The Utilization review specialist is essential to the Brightpoint Health Counseling Center’s operations. This position will review selected patients against the admissio...

Overview: Monitors volume, quality and time frames service authorizations and appropriatesness of services for PACE DD commuicates to nurse care managers and medical management staff alternatives and cost effective options lead in review and correction of claim error report, pend reports to staff, ensuring corrections are made in system and within established timeframes Assists in review of se...

The Utilization Management Nurse will conduct reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination in accordance with Utilization Management policies and procedures. ESSENTIAL FUNCTIONS Perform utilization management, utilization review, or concurrent review (on-site ...

Coordinates the care and services of Long Term Care members across the continuum of illness. Promotes effective utilization and monitors health care resources. Assumes a leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the PCP, member’s family, Supervisor/Manager of Care Management to assess, plan, implement, coordinate, monitor and ev...

Overview: Visiting Nurse Service of New York (VNSNY) is the nation’s largest not-for-profit community-based health system. VNSNY provides a comprehensive array of home- and community-based programs, including health plans, tailored to the needs of high-risk, vulnerable New Yorkers, improving their quality of life. Each day, more than 18,000 VNSNY employees — including nurses, rehabilitation thera...

Overview: Visiting Nurse Service of New York (VNSNY) is the nation’s largest not-for-profit community-based health system. VNSNY provides a comprehensive array of home- and community-based programs, including health plans, tailored to the needs of high-risk, vulnerable New Yorkers, improving their quality of life. Each day, more than 18,000 VNSNY employees — including nurses, rehabilitation thera...

Overview: Oversees prospective, concurrent, and retroactive Utilization Management (UM) activities, including staff leadership, program development, policy and procedure creation and maintenance, and in collaboration with other departments as needed to achieve UM and health plan goals. Responsibilities: * Ability to lead a team required to meet rigid timelines with high accuracy. * Excellent n...

Description: As the Appeals Manager, you will manage the appeals process and act as a hospital liaison to IPRO (Island Peer Review Organization) and other third party reviewers. You will also coordinate and manage utilization issues concurrently and retrospectively as they relate to potential denials related to IPRO, managed care and third party reviewers. Further, you will assist with planning a...

Description: Job Summary: Review medical documentation to achieve results in accurate clinical determination based upon scope of practice. Responsibilities: Reviewing professional medical claims policy related issues or claims in pending status. Make determinations based on clinical reviews, along with federal, state and company guidelines. Prepare cases for external and internal review. Pro...

Description: Job Summary: Review medical documentation to achieve results in accurate clinical determination based upon scope of practice. Responsibilities: Reviewing professional medical claims policy related issues or claims in pending status. Make determinations based on clinical reviews, along with federal, state and company guidelines. Prepare cases for external and internal review. Pr...

Overview Health and Public Service – Healthcare Utilization Management Consultant in New York, NYAccenture Branch New YorkNYUS Position:Health and Public Service – Healthcare Utilization Management ConsultantLocation:New York, NY Health & Public Service Title: Health Management… consulting role 2 years of experience in the healthcare industry 2 years of experience in Utilization… Organization...