Current jobs related to Utilization Review Nurse - New York - Village Care
-
Utilization Review Coordinator
1 week ago
New York, New York, United States StateJobsNY Full timeJob SummaryNew York State Psychiatric Institute is seeking a Utilization Review Coordinator to analyze and evaluate the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Candidates from outside or within State Service can apply for this position under the Hiring for Emergency...
-
Utilization Review Coordinator
2 weeks ago
New York, New York, United States StateJobsNY Full timeJob Title: Utilization Review CoordinatorNew York State Psychiatric Institute is seeking a Utilization Review Coordinator to analyze and evaluate the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key Responsibilities:Review clinical records for completeness and accuracy to...
-
Utilization Review Nurse
2 months ago
New Bern, United States CarolinaEast Health System Full timeJob DescriptionAbout CarolinaEast Medical Center CarolinaEast Health System is dedicated to quality and compassionate care across the Coastal Carolina region. The flagship of the health system is a 350 bed full service medical center housing a complete complement of inpatient and outpatient services with the latest technology. CarolinaEast Health System...
-
Utilization Review Manager
4 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + HospitalsMetroPlusHealth provides the highest...
-
Clinical Utilization Review Nurse
1 month ago
New York, New York, United States VNS Health Full timeJob SummaryVNS Health is seeking a skilled Registered Nurse to join our team as a Clinical Utilization Review Specialist. In this role, you will be responsible for resolving grievances, appeals, and external reviews for our Managed Long Term Care, Medicare Advantage, and Select Health product lines.Key Responsibilities:Investigate and review routine and...
-
Physician Utilization Reviewer
1 month ago
New York, New York, United States Dane Street Full timePhysician Utilization ReviewerDane Street, a certified "Great Place to Work" company, is seeking a skilled Physician to provide utilization review services for the Group Health Department.This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical appropriateness of services in compliance with state...
-
Physician Utilization Reviewer
1 week ago
New York, New York, United States Dane Street Full timeDane Street is seeking a Physician to provide utilization review services for the Group Health Department.This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical appropriateness of services in compliance with state regulations, nationally recognized evidence-based guidelines, and client-specific...
-
Travel Nurse RN Utilization Review
2 weeks ago
New York, New York, United States talent4health Full timeJob Title: Travel Nurse RN Utilization ReviewTalent4Health is seeking a skilled Registered Nurse (RN) for a travel nursing job in a dynamic healthcare setting.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNEmployment Type: TravelKey Responsibilities:Conduct thorough utilization reviews to ensure optimal patient care and resource...
-
Utilization Review Nurse Specialist
3 weeks ago
New Bern, North Carolina, United States CarolinaEast Health System Full timeAbout CarolinaEast Health SystemWe are a leading healthcare provider in the Coastal Carolina region, dedicated to delivering high-quality, compassionate care to our patients.Our 350-bed medical center offers a wide range of inpatient and outpatient services, equipped with the latest technology to ensure the best possible outcomes.We employ over 2,500...
-
Utilization Review Nurse
4 weeks ago
new baltimore, United States Albany Medical Center Full timeNew Baltimore, NY, United States Department/Unit: Care Management/Social WorkWork Shift: Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary: $65,062.40 -$107,348.80• Completes Utilization Management and Quality Screening for assigned patients. • Applies MCG criteria to...
-
Utilization Review Nurse
4 weeks ago
New Baltimore, United States Albany Medical Center Full timeNew Baltimore, NY, United States Department/Unit: Care Management/Social Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Salary: $65,062.40 -$107,348.80• Completes Utilization Management and Quality Screening for assigned patients. • Applies MCG...
-
Clinical Utilization Review Nurse
1 month ago
New Orleans, Louisiana, United States AbsoluteCARE Inc Full timeJob Title: Utilization Review NurseAt AbsoluteCARE Inc, we are seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that our members receive appropriate and high-quality care while minimizing unnecessary utilization and costs.Key Responsibilities:Perform initial, concurrent, and...
-
Medical Director
4 weeks ago
New York, New York, United States Innova Solutions Full timeMedical Director - Utilization ReviewInnova Solutions is seeking a highly skilled Medical Director to lead our Utilization Review team. As a key member of our organization, you will be responsible for ensuring the highest quality of care for our patients.Key Responsibilities:Develop and implement utilization management strategies to optimize patient care and...
-
Medical Director
4 weeks ago
New York, New York, United States Innova Solutions Full timeJob Title: Medical Director - Utilization ReviewInnova Solutions is seeking a highly skilled Medical Director to lead our Utilization Review team. As a key member of our organization, you will be responsible for ensuring that our clients receive high-quality, cost-effective care.Key Responsibilities:Perform utilization management related to inpatient and...
-
Clinical Utilization Review Specialist
3 days ago
New York, New York, United States Dane Street Full timeDane Street, a certified "Great Place to Work" company, is seeking a Physician to provide utilization review services for the Group Health Department.This role requires utilizing clinical expertise to review medical records and provide an interpretation of the medical appropriateness of services in compliance with state regulations, nationally recognized...
-
Clinical Utilization Review Nurse
3 days ago
New Orleans, Louisiana, United States AbsoluteCARE Inc Full timeJob Summary:The Utilization Review Nurse will ensure appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with health plans and different providers/care teams to help ensure inpatient bed days and associated discharge/transitional care plans are...
-
Drug Utilization Review Specialist
2 weeks ago
New York, New York, United States destinationone Consulting Full timeJob Title: Drug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a crucial role in evaluating medication use patterns to promote safe and effective medication therapy.Key Responsibilities:Conduct...
-
Drug Utilization Review Specialist
1 week ago
New York, New York, United States destinationone Consulting Full timeDrug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a crucial role in evaluating medication use patterns to promote safe and effective medication therapy, ensuring optimal patient outcomes.Key...
-
Utilization Review Nurse
3 weeks ago
New Baltimore, Michigan, United States Albany Medical Center Full timeJob Title: Utilization Review NurseAlbany Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate and cost-effective care.Responsibilities:Conduct thorough reviews of patient records to identify areas for improvement in...
-
Drug Utilization Review Specialist
4 weeks ago
New York, New York, United States destinationone Consulting Full timeJob Overviewdestinationone Consulting is a leading recruitment agency specializing in diverse sectors, including Healthcare, Health Tech, Government, Municipalities, Non-Profits, Legal, Public Accounting, and more. We are building a comprehensive database of opportunities in these fields. By applying, you ensure our recruiters can efficiently match you with...
Utilization Review Nurse
3 months ago
RN- Utilization Review Nurse
LTSS
*Full Time 100% Remote Opportunity*
COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE
VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services. Some of your daily activities will include:
- Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria - prospective, concurrent and retrospective review.
- Frequently collaborates and communicates with physician peer reviewers and medical directors in determining coverage of requested services.
- Provide intervention and coordination to decrease delays and denials.
- Maintains timely, complete and accurate documentation in compliance with VCMAX policies and procedures.
- Support Quality and Performance Improvement Initiatives.
- Timely follow-up on results of denial and internal appeal reviews.
We would like to speak to those who have a current unrestricted NYS RN license to practice professional nursing, URAC preferred. Seeking those who bring a BSN (advanced degree preferred), along with 2+ years of utilization review experience at a Managed Care Organization or Health Plan required. Experience in MLTC - understanding of authorizing PCA, DME, PERS, and SADC. Working knowledge of Medicaid and/or Medicare regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines will be vital to this role.
There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you
- PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, Additional Employee Discounts
VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.
VillageCare is an Equal Opportunity Employer.
Job Posted by ApplicantPro
