Utilization review nurse [h1.location_city]

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Utilization review nurse • jersey city nj

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Utilization Review Nurse

Village CareNew York, NY, USA

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Must reside within the New York Tri-State Area - NY, NJ, or CT.COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE!. VillageCare is looking for a self-motivated and passionate RN as...[show_more][last_updated.last_updated_variable_days]

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Utilization Review Specialist

Odyssey HouseNew York, NY, United States

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REPORTS : Director of Utilization Review.George Rosenfield Center for Recovery - 13 Hell Gate Circle, Ward's Island, NY 10035. Under the direction of the Director of Utilization Review, the Specialis...[show_more][last_updated.last_updated_variable_days]

Physician Reviewer - Psychiatry (Utilization Review)

Dane Street, LLCNew York, NY, US

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Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Psychiatrist with an active New Yo...[show_more][last_updated.last_updated_30]

Utilization Review Nurse

VillageCareNew York, NY, United States

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Maine Licensed Utilization Review Nurse

VirtualVocationsAstoria, New York, United States

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A company is looking for a Utilization Review Nurse - Remote.Key Responsibilities Review prior authorization requests for medical necessity and collaborate with healthcare providers Manage medic...[show_more][last_updated.last_updated_variable_days]

Utilization Review Specialist

Odyssey House INCNew York, NY, US

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Formulary Strategy & Utilization Review Pharmacist

Pharmacy CareersNew York, NY, United States

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Formulary Strategy & Utilization Review Pharmacist.Shape the drug benefit landscape-analyze and optimize medication use.Review prescribing trends and propose cost-saving alternatives.Maintain evide...[show_more][last_updated.last_updated_30]

Utilization Manager

Acacia NetworkNew York, NY, US

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Are you ready to give back to the community while pursuing your passion? For over 50 years, Acacia Network and its affiliates have been committed to improving the quality-of-life and wellbeing of u...[show_more][last_updated.last_updated_30]

Physician Utilization Management Reviewer - Remote

XBP GlobalNew York, NY, United States

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Job Overview We are building a pipeline of experienced Licensed Physicians and Registered Nurses and to support Utilization Management (UM) review services. These are remote, non-bedside roles ideal...[show_more][last_updated.last_updated_variable_days]

Registered Nurse Case Manager Utilization Review Chart Abstractor PRN

United Surgical PartnersBrooklyn, NY, United States

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NYU Grossman School of Medicine.For 175 years, NYU Grossman School of Medicine has trained thousands of physicians and scientists who have helped to shape the course of medical history and enrich t...[show_more][last_updated.last_updated_variable_days]

Utilization Review Physician - New Jersey (Mostly Remote)

Vivo HealthStaffNewark, NJ, US

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Vivo HealthStaff is recruiting for a.New Jersey for a Managed Care Insurance Plan.This position requires 4 days per month on-site. The Utilization Review Physician is the lead clinician for the heal...[show_more][last_updated.last_updated_30]

RN Case Manager / Utilization Review - Syracuse

Greenlife Healthcare StaffingNew York, New York

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RN Case Manager / Utilization Review - Syracuse, NY (#25268).Acute Care / Academic Medical Center, Syracuse, NY.About Greenlife Healthcare Staffing : . Greenlife Healthcare Staffing is a leading nationw...[show_more][last_updated.last_updated_30]

Medical Director (Utilization Reviewer)

Medical Review InstituteNew York, NY, United States

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Medical Director (Physician Reviewer) Full-Time | Remote (U.Based) Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review servi...[show_more][last_updated.last_updated_variable_days]

Utilization Review Nurse

Christian Health Care CenterNJ, US

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We have had the privilege of caring for those in need for more than a century.Founded on the belief that everyone has the right to exceptional care, today we continue to provide quality care and se...[show_more][last_updated.last_updated_30]

Utilization Management Nurse Consultant

CVS HealthNew York, Work At Home, US

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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who...[show_more][last_updated.last_updated_30]

Remote Utilization Review Nurse (RN)

Attune PharmaceuticalsNew York City, New York, United States

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Join Attune Pharmaceuticals and Shape the Future of Patient-Centered Care Attune Pharmaceuticals is seeking a detail-oriented, clinically astute Remote ...[show_more][last_updated.last_updated_1_day]

Utilization Manager

Human EdgeManhattan, NY

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In concert with the agency's mission and goal of sustaining high quality care / service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as n...[show_more][last_updated.last_updated_30]

Utilization Review Nurse

SUNY Downstate Health Sciences UniversityBrooklyn, New York, USA

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Are you looking to take your career to new heights with a leader in healthcare SUNY Downstate Health Sciences University is one of the nations leading metropolitan medical centers.As the only acade...[show_more][last_updated.last_updated_variable_days]

Utilization Review Director - Newark NJ

VITUS Search GroupNewark, NJ, US

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Vitus Search Group has had the privilege of working with a massive Healthcare Firm out of St Louis MO over the last year and we are only getting started . We are in search of multiple Utilizati...[show_more][last_updated.last_updated_variable_days]

Utilization Review Nurse

Village CareNew York, NY, USA

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RN- Utilization Review Nurse

Inpatient

Hybrid

Must reside within the New York Tri-State Area - NY, NJ, or CT

COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE!

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. 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. Must have a minimum of 1 year long term support service experience . Inpatient experience required. MLTC and Hospital / SNF experience required.

Must reside within the New York Tri-State Area - NY, NJ, or CT.

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.

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