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Utilization Review Nurse Jobs in New York

13 jobs

We have been retained by one of New York States largest managed care insurers seeking a Utilization Review Nurse Supervisor. This is a direct hire opportunity in the Capital Region with a generous salary and benefit package. Ideal candidates will possess the following: RN license (NYS). BSN preferred. 3-5 years supervisory experience. Expertise in utilization management & review, compliance, a...
Job Summary Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appr...
Company InformationSolid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.Job SummaryUnder moderate supervision, provid...
Job Opening ID 5766BR Title Nurse Medical Case Mgr/ Utilization Review Nurse Country United States State/Region/Province New York City Buffalo Job Category Nurse - Medical Case Manager Target Openings 2 Position Type Experienced/Professional Company Information Solid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent re...
Facilitates a process of assessment, planning and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost effective care. Validates appropriate level of care (severity of illness), efficient and effective care delivery (intensity of services) and safe discharge to the next appropriate level of care. Conducts admiss...
As a Utilization Review Nurse you will review and coordinate prospective, concurrent and retrospective activities related to utilization. Monitor documentations for accuracy and clinical compliance. Organize and coordinate activities within the organization in accordance with standards of State and Federal regulations; and in accordance with accreditation and other guidelines. RESPONSIBILITIES •...
As a Utilization Review Nurse you will review and coordinate prospective, concurrent and retrospective activities related to utilization. Monitor documentations for accuracy and clinical compliance. Organize and coordinate activities within the organization in accordance with standards of State and Federal regulations; and in accordance with accreditation and other guidelines. RESPONSIBILITIES •...
Description: As a Utilization Review Nurse you will review and coordinate prospective, concurrent and retrospective activities related to utilization. Monitor documentations for accuracy and clinical compliance. Organize and coordinate activities within the organization in accordance with standards of State and Federal regulations; and in accordance with accreditation and other guidelines. RESPO...
Performance Management Performance Management Formal Education: Associate Degree or certification equivalent Experience: 5 years License, Registration, and / or Certification Requirement: Yes Minimum Knowledge: Requires advanced knowledge of a specialized or technical field or a thorough knowledge of the practices and techniques of a professional field. Language Ability: Ability to read and ...
Overview: Performance Management 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 compli...
Knowledge and Skills: - RN with active state license - Supervisory experience and ability to manage and lead a small team of employees - Strong Utilization Review professional background preferred or at least 4 years recent clinical experience - Exceptional interpersonal skills with excellent written and verbal skills - Knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered ser...
Requisition Number: 3544 Job Title: Nurse/Utilization Review Manager Area of Interest: Healthcare City: Albany State/Province: New York Requirements: Knowledge and Skills: - RN with active state license - Supervisory experience and ability to manage and lead a small team of employees - Strong Utilization Review professional background preferred or at least 4 years recent clinical experien...
Reviews incoming precertification requests for authorization retrieval: Answers incoming calls from requesting physician office/provider. Obtains patient identification information, i.e. name, date of birth, etc. Obtains service request details, i.e. date of service, facility, requesting provider, etc. Obtains clinical service information, i.e. diagnosis/procedure code, etc. for clinical team....