Utilization Review Nurse Jobs in New York City, New York

405 jobs

Kingsbrook and you. Enhancing a patient’s quality of life. Comforting a family in difficult times. Creating hope in challenging situations. As a member of Kingsbrook Jewish Medical Center’s talented team of caregivers, these are the things you’ll achieve-each and every day. When you partner with us, you’ll provide highly personalized, compassionate care to patients and families when they need it ...

Patient Utilization Review NurseMount Sinai Health System - New York Experience with clinical system design, and project management skills are a plus; Clinical assessment, EMR documentation, setting priorities and developing care plans. Sinai Health System, we use the title Patient Utilization Review Nurse instead of case coordinator or case manager because your role is caring for patients, not m...

“Engaging Talent for Extraordinary Careers” You may know Mt. Sinai Health System by our hospitals. Beth Israel Medical Center , 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 of New York City ’s most distinguished health care providers. Mt. Sinai Health System prides itself on innovative care...

The Mount Sinai Health System Do you have what it takes to wear the badge? The Mount Sinai Health System’s commitment to excellence extends beyond delivering world-class health care. The System’s ongoing success is dependent upon our highly motivated, nonclinical professionals working to improve business operations. Our leadership team is driven to provide exceptional service by cultivating a wo...

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 services following evaluation of medical guidelines and benefit determina...

Supervisor of Utilization Management (RN, BS/BA) - Managed Care Buffalo, NY Your Job Summary: The Utilization Management Supervisor supports the Manager in overseeing the day-to day operations of the UM staff to ensure all contract requirements and business initiatives are completed successfully and timely. The role of Utilization Management Supervisor is to promote the quality and cost effecti...

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 ...

*LI-JH1 Manages the activities of supervisory associates and their subordinate work group(s), and/or exempt individual contributors for assigned area of responsibility. Works with the Care Managers to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member. Essential Functions: Manages and develops direct reports who include superviso...

Manages the activities of supervisory associates and their subordinate work group(s), and/or exempt individual contributors for assigned area of responsibility. Works with the Care Managers to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member. Essential Functions: Manages and develops direct reports who include supervisory and/or...

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse you will be responsi...

Overview: Responsible for oversight and approval of agency Medicare/Medicaid client base to include appropriate discipline utilization and appropriate plan goals. Ensures quality home care services with consideration of financial reimbursement, Joint Commission and Medicare regulations and agency guidelines. Focuses on staff education related to appropriate discipline and planned resource use. R...

Director of Utilization Management PRIMARY RESPONSIBILITIES: Provides leadership emphasizing utilization management program development, process improvement, implementation and measurement of quality metrics. Interprets and implements utilization management criteria and clinical standards. Oversees day to day functioning of the Utilization department, to identify issues and to be able to develop...

Description: Job Summary: This position is accountable for the detection, investigation, resolution and prevention of utilization abuse and mismanagement of BCBS benefits by providers and subscribers. Assists in the development and implementation of all projects and programs, which support the Plan's Cost Containment efforts. Responsibilities: Identify possible cases of abusive billing or inapp...

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...

JOB TITLE: Utilization Management Nurse- Behavioral Health Services DEPARTMENT TITLE: Utilization Management Nurse - Behavioral Health Services DEPARTMENT: Clinical Operations LOCATION: Brooklyn, New York JOB SUMMARY Responsible for the coordination of utilization management and care management activities necessary to ensure a member’s Behavioral Health services meets URAC, NCQA, NY State and ...

Job Description POSITION SUMMARY Clinical leader of Utilization Management Department for new FIDA health plan. Fundamental Components: Responsibilities include: 1. Using evidence based clinical criteria to establish standars for approva; of requested services within the benefit plan and under the direction of the Medical Director 2. Lead staff of nurses and support staff to make decisions w...

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...

Clinical Coverage Review Medical Director The Medical Director provides physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related ...

Clinical Coverage Review Medical Director The Medical Director provides physician support to Clinical Coverage Review (CCR) operations, the organization responsible for the initial clinical review of service requests for UnitedHealth Care (UHC). The Medical Director collaborates with CCR leadership and staff to establish, implement, support and maintain clinical and operational processes related ...