We have other current jobs related to this field that you can find below
-
New York, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York.Job Description & RequirementsSpecialty: Utilization ReviewDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines Managed Long...
-
West New York, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic for a nursing job in West New York, New Jersey.Job Description & RequirementsSpecialty: ClinicDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffOur clinical care management services are anchored in evidence-based practices to optimize the utilization of healthcare benefits and services....
-
West New York, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic for a nursing job in West New York, New Jersey.Job Description & RequirementsSpecialty: ClinicDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffOur clinical care management services are anchored in evidence-based practices to optimize the utilization of healthcare benefits and services....
-
New York, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic Case Management for a nursing job in Manhattan, New York.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffEnsures the quality, safe delivery, and cost-effective home care services. Coordinates home care services that reflect VNS...
-
West New York, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Manager, Educator for a nursing job in West New York, New Jersey.Job Description & RequirementsSpecialty: EducatorDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffPlans, manages, and evaluates clinical orientation and ongoing education and training programs for staff for one or more programs...
-
West New York, United States VNS Health Full timeVNS Health is seeking a Registered Nurse (RN) Clinic Case Management for a nursing job in West New York, New Jersey.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffEnsures the quality, safe delivery, and cost-effective home care services. Coordinates home care services that reflect...
-
Clinical Nurse Reviewer
6 days ago
New York, New York, United States Confident Staff Solutions Full timePosition OverviewDepartment: Utilization ManagementWork Schedule: Monday to Friday, 7:30 AM - 4:00 PM (40 hours per week)Unit Details: ICU - 8 beds, Medical - 25 beds, Surgical - 25 beds. Familiarity with Meditech is preferred.Key ResponsibilitiesConduct concurrent evaluations of patient clinical data to ensure efficiency.Review precertification requests...
-
Registered Nurse
6 days ago
New York, New York, United States Confident Staff Solutions Full timePosition OverviewDepartment: Utilization ManagementWork Schedule: Monday to Friday, 7:30 AM - 4:00 PM (40 hours per week)Unit Details: ICU - 8 beds, Medical - 25 beds, Surgical - 25 beds. Familiarity with Meditech is preferred.Key Responsibilities:Conduct ongoing evaluations of patient clinical data to ensure efficiency in care delivery.Review...
-
Social Work
3 weeks ago
New York, United States VNS Health Full timeVNS Health is seeking a Social Work Clinic Social Worker for a job in Manhattan, New York.Job Description & RequirementsSpecialty: Social WorkerDiscipline: Social WorkStart Date: ASAPDuration: OngoingEmployment Type: StaffProvides telephonic clinical care management services using evidence-based practices to ensure effective utilization of benefits,...
-
Social Work
3 weeks ago
New York, United States VNS Health Full timeVNS Health is seeking a Social Work Clinic Social Worker for a job in Manhattan, New York. Job Description & Requirements Specialty: Social WorkerDiscipline: Social WorkStart Date: ASAPDuration: OngoingEmployment Type: StaffProvides telephonic clinical care management services using evidence-based practices to ensure effective utilization of benefits,...
-
Registered Nurse Clinical Reviewer
1 month ago
New York, United States Greenlife Healthcare Staffing Full time $50JOB TITLE (#25026): Registered Nurse Clinical Reviewer / IDR - Remote Minimum of 3 years experience in a medical review settingGreenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer to fill an opening with a Non-profit organization located in New YorkRequirements of the Registered Nurse Clinical Reviewer:Must have a...
-
RN Utilization Review
4 weeks ago
New York, New York, United States V R Della IT Services Private Limited Full time## Job OverviewWe are seeking a dedicated Utilization Review Nurse to join our healthcare team. The ideal candidate will be responsible for reviewing medical records to ensure that patients receive necessary care and treatment while optimizing healthcare resources.-*Job Description**Initial and concurrent Status Reviews, MDR's, Denial work.*Requirements**RN...
-
Utilization Review Nurse
4 weeks ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionRN- 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...
-
Utilization Management Reviewer
1 month ago
New York, New York, United States tapwage Full timeJob Description:Summary:This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ensuring compliance with internal and external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and...
-
New York, NY, United States Tact Staff Full timeTact Staff is seeking a travel nurse RN Ambulatory Care for a travel nursing job in New York, New York. Job Description & Requirements ~ Specialty: Ambulatory Care ~ Discipline: RN ~ Start Date: 09/16/2024 ~ Duration: 13 weeks ~36 hours per week ~ Shift: 12 hours ~ Employment Type: Travel Ambulatory Care Nursing - Mount Sinai Hospital Summary:...
-
Utilization Review Coordinator
2 days ago
New York, New York, United States StateJobsNY Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at StateJobsNY. As a key member of our healthcare operations team, you will be responsible for analyzing and evaluating the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key...
-
Utilization Review Coordinator
13 hours ago
New York, New York, United States StateJobsNY Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at StateJobsNY. As a key member of our healthcare operations team, you will play a critical role in analyzing and evaluating the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key...
-
Utilization Review Coordinator
13 hours ago
New York, New York, United States StateJobsNY Full timeJob SummaryWe are seeking a highly skilled Utilization Review Coordinator to join our team at StateJobsNY. As a key member of our healthcare operations team, you will play a critical role in analyzing and evaluating the quality, effectiveness, and efficiency of psychiatric and medical services provided to individuals diagnosed with mental illness.Key...
-
Rn Nursing Staff Position
3 weeks ago
New York, NY, United States Tact Staff Full timeTact Staff is seeking a travel nurse RN Psychiatric for a travel nursing job in New York, New York. Job Description & Requirements ~ Specialty: Psychiatric ~ Discipline: RN ~ Start Date: 09/16/2024 ~ Duration: 13 weeks ~36 hours per week ~ Shift: 12 hours ~ Employment Type: Travel Psych Unit - Mount Sinai Beth Israel Summary: The Clinical...
-
Rn Nursing Staff Position
3 weeks ago
New York, NY, United States Tact Staff Full timeTact Staff is seeking a travel nurse RN Psychiatric for a travel nursing job in New York, New York. Job Description & Requirements ~ Specialty: Psychiatric ~ Discipline: RN ~ Start Date: 09/16/2024 ~ Duration: 13 weeks ~36 hours per week ~ Shift: 12 hours ~ Employment Type: Travel Psych Unit - Mount Sinai Beth Israel Summary: The Clinical...
![VNS Health](https://media.trabajo.org/img/noimg.jpg)
staff - Registered Nurse (RN) - Clinic Utilization Review - $93K-117K per year
2 months ago
VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York.Job Description & Requirements
Specialty:
Utilization ReviewDiscipline:
RNStart Date:
ASAPDuration:
OngoingEmployment Type:
StaffResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day operations according to defined processes and procedures. Creates and maintains accurate records documenting the actions and rationale for each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting data. Works under general supervision.What We ProvideAttractive sign-on bonus and referral bonus opportunitiesGenerous paid time off (PTO), starting at30 days of paid time offand 9 company holidaysHealth insurance plan for you and your loved ones, Medical, Dental, Vision, Life and DisabilityEmployer-matched retirement saving fundsPersonal and financial wellness programsPre-tax flexible spending accounts (FSAs) for healthcare and dependent careGenerous tuition reimbursement for qualifying degreesOpportunities for professional growth and career advancementInternal mobility, generous tuition reimbursement, CEU credits, and advancement opportunitiesWhat You Will DoDevelops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements.Investigates and reviews routine and complex situations and underlying issues, analyzes and solves problems, focusing primarily on issues of medical necessity, quality of care, long term services and supports, etc.. Consults with the member, family, providers and health plan departments as necessary. Identifies and communicates key points from details.Investigates and coordinates the resolution of routine and complex grievances and appeals according to defined processes and procedures ensuring that required timeframes and regulatory requirements are met, accurate and timely follow up is completed and activities are documented as required.Reviews covered and coordinated services in accordance with established plan benefits, application of medical criteria and regulatory requirements to ensure appropriate appeal resolution and execution of the plan’s fiduciary responsibilities. Prepares records for physician review as needed.Conducts review of requests for prior authorization of health services, as required in certain product lines, and prepares written responses consistent with regulatory requirements.Coordinates external case reviews requested by enrollees, including preparing and submitting documentation according to regulatory requirements and tracking external reviews throughout the process. External reviewers include New York State (Fair Hearings), Centers for Medicare and Medicaid Services (CMS), Independent Review Entities and Quality Improvement Organizations.Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator staff and legal, as necessary, to investigate and facilitate resolution of individual grievances and appeals. Consults with enrollees, providers and the Medical Director, as appropriate.Provides input and recommendations for design and development of policies, processes and procedures for improved department operations and customer service.Reviews information available from Medicaid, Medicare, other payers, and/or professional medical organizations regarding benefit levels and medical necessity criteria.Enters data and assists with compiling reports and analysis on the grievance and appeals process.Licenses and Certifications:License and current registration to practice as a registered professional nurse in New York State required
Do you have the skills to fill this role Read the complete details below, and make your application today.Education:Bachelor's Degree in Nursing requiredMaster’s Degree in Nursing preferred
Work Experience:Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management requiredProficient computer and typing skills and knowledge of Microsoft Office (Word and Excel) requiredAbility to work in a fast paced environment and effectively manage multiple grievances and appeals simultaneously.
VNS Health Job ID #R010257. Posted job title: Rn Utilization Review, Clinical-2About VNS Health VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 125 years, our commitment to health and well-being is what drives us—we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of those we serve in New York and beyond.Benefits
Guaranteed Hours401k retirement planEmployee assistance programsDental benefitsVision benefitsLicense and certification reimbursementLife insuranceDiscount programHoliday PayContinuing EducationWellness and fitness programsMileage reimbursementMedical benefitsBenefits start day 1
#J-18808-Ljbffr