Utilization Review Nurse Jobs in New York City, New York

467 jobs

Case Management & Utilization Review Nurse (RN) – Managed Care New York, NY (Downtown Manhattan) *** This is a full-time, benefits available, CONTRACT position, expected to last 3-4 months, or longer! *** Your Job Summary: As a member of the medical management team, the Case Management & Utilization Review Nurse plays an integral part in the coordination of care assessing the member’s conditio...

Nurse Reviewer 5MONTH CONTRACT EMPLOYMENT LOCATION: New York, NY Every day, Kelly Services connects professionals with opportunities to advance their careers. We are currently recruiting for an exciting contract opportunity as a Nurse Reviewer with our large medical insurance client. This is a full time day shift position. No weekends No holidays! SUMMARY: Responsible for reviewing and making ...

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...

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...

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...

Responsibilities: This position is responsible for performing RN duties using established Milliman/MCG/CareWebQI guidelines to ensure appropriate level of care, providing authorizations of services & planning the transition of care across the continuum. He/She will perform duties & types of care management as assigned. This is achieved with having accountability for, but is not limited to, all of...

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...

Description: You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take...

Description: You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take...

Company Description Managed Care Health Plan Job Description Utilization Management Nurse ?Managed Care Company located in the Bronx seeks a Utilization Management Nurse for an immediate temp to perm position.? ?PURPOSE OF THE POSITION: ?The Utilization Management Nurse will conduct reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient servi...

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...

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: 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...

Medical Review Stream by Concentra is currently looking for a board certified Neurosurgeon licensed in New York for peer review. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and pe...

Company Confidential
Job Purpose: Promotes and restores patients' health by developing day-to-day management and long-term planning of the patient care area; directing and developing staff; collaborating with physicians and multidisciplinary professional staffs; providing physical and psychological support for patients, friends, and families. Duties: * Accomplishes nursing human resource objectives by selecting, or...

Healthcare company seeking Pre authorization LPN for immediate hire. Pre-authorization LPN - Must have pre-authorization experience. Process requests for selected elective services, out of network requests, out of area requests and durable medical equipment in accordance with departmental criteria, regulatory standards, and Medicare guidelines. Documents all requests and telephone encounters for s...

Description: Job Summary: Provides case management services for workers compensation cases with lost time, complex medical care, and/or high medical utilization. Ensures appropriateness and cost effectiveness of care, and optimal outcomes. Coordinates cases with internal and external claim representatives, clients, employees, providers and attorneys. Responsibilities: Performs initial and ongo...

Job Title: Primary Care Nurse Practitioner or Physician Assistant Job ID: BC6-2015 Location: Brooklyn College Health Clinic (BCHC) Part-Time: Monday – Thursday; hours are flexible The Brooklyn College Health Clinic seeks a compassionate and highly-skilled primary care nurse practitioner or physician assistant to join our dedicated, passionate and collegial team. The BCHC is a non-profit outpat...