Utilization Review Nurse Jobs in New York, NY
Jobot
$105000 - $115000
Queens, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. The Nurse Care Manager will work with the member and/or family member to maintain the most independent living situation possible; ensure consistent care along the entire health care continuum by assessing and closely monitoring member’s needs and status.
Yale New Haven Health
Stamford, CT
Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
Yale New Haven Health
Stamford, CT
Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
Yale New Haven Health
Cos Cob, CT
Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
Yale New Haven Health
Stamford, CT
Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
Yale New Haven Health
Stamford, CT
Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
Yale New Haven Health
Stamford, CT
Demonstrates Competency In The Care Of The Neuro Patient # Demonstrates Skill And Knowledge In Neuro Assessment # Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient # Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures # Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace # Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. # Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process.
Yale New Haven Health
Stamford, CT
Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process. The Registered Nurse (Rn) Assesses, Plans, Implements, Evaluates And Supervises Individual Patient Care On A Nursing Unit/Department According To Unit Policies And Procedures.
BoldAge PACE
$90000 - $110000
East Brunswick, NJ
Provide coordination and direct care as indicated to promote continued care in the community or promote optimal institutional care (Assisted Living, Nursing Home, Hospital, etc.) as needed. Teach participants, caregivers and families about self-care, medications, healthy lifestyles, infection control and safety to promote optimal health and safety.
Jobot
$106000 - $125300
Queens, NY
This full-time position will function with leadership administrative duties, oversee a team of homecare nurses, precepting new nurses, supervising your peers on their field visits, conducting regular supervisory home visits with nursing staff to ensure clinical competence, to provide guidance in caring for patients with various diagnoses, to address patient/family concerns. Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal.
Jobot
$115000 - $120000
New York, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners.
Jersey City Medical Center
Jersey City, NJ
Leadership & Management responsibilities including oversee day-to-day operations: Manage staff schedules, assignments, and workflow to ensure optimal patient care delivery and resource utilization; develop and mentor staff: Coach, mentor, and provide regular feedback to staff; conduct performance evaluations, identify training needs, and support professional development; promote a positive work environment; foster a collaborative and supportive team environment that values teamwork, communication, and accountability; manage employee performance; address performance issues promptly and effectively, ensuring fair and consistent treatment; participate in hiring and onboarding; assist in the recruitment, selection, and onboarding of new staff. Clinical Excellence & Patient Care responsibilities including ensure quality patient care: Oversee the delivery of high-quality, patient-centered care, ensuring adherence to clinical protocols, best practices, and regulatory requirements; facilitate efficient patient flow; proactively identify and resolve delays in patient throughput, minimizing length of stay and optimizing resource utilization; support utilization review: Collaborate with physicians and the physician advisor in utilization review escalations, ensuring appropriate and timely care, and conduct risk assessments: Identify and mitigate potential risks to patient safety and quality of care.
Jobot
$105000 - $110000
New York, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Successfully engage patient/caregiver to develop an individualized plan of care, promote healthy lifestyles, close gaps in care, and reduce unnecessary emergency room utilization and hospital readmissions.
Jobot
$105000 - $125000
Yonkers, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Successfully engage patient/caregiver to develop an individualized plan of care, promote healthy lifestyles, close gaps in care, and reduce unnecessary emergency room utilization and hospital readmissions.
Jobot
$105000 - $110000
New York, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Successfully engage patient/caregiver to develop an individualized plan of care, promote healthy lifestyles, close gaps in care, and reduce unnecessary emergency room utilization and hospital readmissions.
Jobot
$105000 - $110000
New York, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Successfully engage patient/caregiver to develop an individualized plan of care, promote healthy lifestyles, close gaps in care, and reduce unnecessary emergency room utilization and hospital readmissions.
Jobot
$105000 - $110000
Queens, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Successfully engage patient/caregiver to develop an individualized plan of care, promote healthy lifestyles, close gaps in care, and reduce unnecessary emergency room utilization and hospital readmissions.
Yale New Haven Health
Stamford, CT
Demonstrates Competency In The Care Of The Neuro Patient # Demonstrates Skill And Knowledge In Neuro Assessment # Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient # Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures # Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace # Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. # Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process.
Yale New Haven Health
Stamford, CT
Nursing staff are trained in advanced heart failure management, including short- and long-term mechanical circulatory support (with devices such as intra-aortic balloon pumps, Impella catheters, and LVADs) and evaluation for advanced therapies and transplantation. The Cardiac ICU is a fast paced, high acuity, 14-bed, critical care unit that cares for adult patients with complex cardiac, medical diagnoses such as myocardial infarction, cardiogenic shock, unstable arrhythmias, and heart failure.
Yale New Haven Health
New Canaan, CT
Demonstrates Competency In The Care Of The Neuro Patient Demonstrates Skill And Knowledge In Neuro Assessment Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. This specialized department caters to both medical oncology patients, who receive systemic therapies like chemotherapy, immunotherapy, and targeted therapies, and surgical oncology patients, who are in various stages of their surgical journey, including pre-operative evaluation, post-operative care, and follow-up.
Yale New Haven Health
Stamford, CT
Demonstrates Competency In The Care Of The Neuro Patient # Demonstrates Skill And Knowledge In Neuro Assessment # Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient # Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures # Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace # Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. # Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process.
Yale New Haven Health
Darien, CT
Demonstrates Competency In The Care Of The Neuro Patient Demonstrates Skill And Knowledge In Neuro Assessment Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process.
Yale New Haven Health
Stamford, CT
Demonstrates Competency In The Care Of The Neuro Patient # Demonstrates Skill And Knowledge In Neuro Assessment # Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient # Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures # Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace # Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. # Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process.
Yale New Haven Health
Old Greenwich, CT
Demonstrates Competency In The Care Of The Neuro Patient # Demonstrates Skill And Knowledge In Neuro Assessment # Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient # Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures # Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace # Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. # Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process.
Yale New Haven Health
Stamford, CT
Demonstrates Competency In The Care Of The Neuro Patient # Demonstrates Skill And Knowledge In Neuro Assessment # Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient # Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures # Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace # Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator Graduate Of An Accredited School Of Nursing; Proficient In Use Of Computer Software To Include Electronic Patient Records. This specialized department caters to both medical oncology patients, who receive systemic therapies like chemotherapy, immunotherapy, and targeted therapies, and surgical oncology patients, who are in various stages of their surgical journey, including pre-operative evaluation, post-operative care, and follow-up.
Intermountain Health
Jersey City, NJ
The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure efficient, effective, and patient-focused care management. Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
A-Line Staffing Solutions LLC
$97500 - $130000
Bernardsville, NJ
Perform patient assessments to determine appropriateness for hospice care and evaluate patient progress toward care goals . • Assist with onboarding and mentorship of new staff members and cross-train to support additional care functions.
A-Line Staffing Solutions.
$97500 - $130000
Bernards, NJ
The ideal candidate will provide exceptional end-of-life care, ensuring patients and their families receive the highest level of comfort, dignity, and support. 2 Shifts available: 1. 8a-4p Mon-Fri (1 weekend per month required) 2. 11a - 7p Mon-Fri (1 weekend per month required).
Jobot
$115000 - $120000
New York, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Reporting to the Supervisor of Care Management this position will provide case management to our members including medical, social, psychological, physical, and spiritual needs by developing, implementing, and monitoring the care plan in.
Cooperman Barnabas Medical Center
Livingston, NJ
The Case Manager coordinates the healthcare needs of patients in the hospital by collaborating with members of the interdisciplinary Patient Care Team and the Primary Care Physician on the in-hospital and post-discharge plan of care. RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering best-in-class work experience to every member of the team.
Jobot
$105000 - $115000
Staten Island, NY
Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. Successfully engage patient/caregiver to develop an individualized plan of care, promote healthy lifestyles, close gaps in care, and reduce unnecessary emergency room utilization and hospital readmissions.
A-Line Staffing Solutions LLC
$52 - $58
The Bronx, NY
Keywords: UAS, URAC, CCM, BSN, ADN, ASN, Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls, URAC, CCM, BSN, ADN, ASN, Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls, URAC, CCM, BSN, ADN, ASN, Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls. Travel to the members' homes to conduct the visit and assessment,• Accurately document assessment results according to the provided documentation template• Review all documentation and utilize Lenavi to identify inconsistencies that need to be corrected or validated.•
ProKatchers
$65 - $70
New York, NY
We are seeking experienced Registered Nurses (RNs) with a strong background in Case Management and Utilization Management for a 13-week contract assignment in New York, NY. This role focuses on case/resource management, utilization review, and coordination of care within a professional review organization setting.
VNS Health
$66300 - $79800
Brooklyn, NY
Minimum of two years of mental health work experience providing direct services to clients/members with Serious Mental Illness (SMI), developmental disabilities, substance use disorders and/or chronic medical conditions required Effective oral/written/interpersonal communication skills required Bilingual skills may be required as determined by operational needs. 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 the communities and people we serve in New York and beyond.
Dane Street
Stamford, CT
Our organization is a URAC accredited leader in IME and Record Review services, currently working with over 170 Work Comp, Disability, Group Health, Auto Liability Carriers, Third Party Administrators, Managed Care Organizations, Employers, Pharmacy Benefit Managers, and Medicare Set-Aside providers to provide customized peer review and IME programs which assist their RN's and adjustors in reaching appropriate medical determinations as part of the claims management process. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers.
St. John's Riverside Hospital
Yonkers, New York
Serving the Westchester community from Yonkers to the river town communities of Hastings-on-Hudson, Ardsley, Dobbs Ferry and Irvington, St. John's Riverside has been and continues to be a unique and comprehensive network of medical professionals dedicated to a tradition of service that spans generations. Responsibilities: The Senior Manager of Utilization Review & Denials provides leadership and oversight for the hospital’s Utilization Review (UR) and denial prevention program to ensure appropriate utilization of healthcare services, regulatory compliance, and optimal reimbursement.
Metropolitan Jewish Health System
New York, New York
Supervises the assessment and coordination of the members physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including treating physician, PCP, utilization managers, social workers, discharge planners. The MJHS Difference: At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
VNS Health
$85000 - $106300
New York, New York
What You Will Do:Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary. Working knowledge of Microsoft Excel, Power-Point, and Word and strong typing skills required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred.
Hackensack Meridian Health
Edison, New Jersey
Responsibilities: A day in the life of a Care Management, Care Coordinator, Utilization Management at Hackensack Meridian Health includes: Follows departmental workflows for utilization review activities including admission reviews, admission denials, continued stay reviews, continued stay denials, termination of benefits, communication of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.
Hackensack Meridian Health
Holmdel, New Jersey
Responsibilities: A day in the life of a Care Management, Care Coordinator, Utilization Managemen at Hackensack Meridian Health includes: Follows departmental workflows for utilization review activities including admission reviews, admission denials, continued stay reviews, continued stay denials, termination of benefits, communication of information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.
Concentra Career Choice
Newark, New Jersey
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Concentra Career Choice
Newark, New Jersey
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Concentra Career Choice
Newark, New Jersey
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Concentra Career Choice
Newark, New Jersey
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
Metropolitan Jewish Health System
New York, New York
The DME Review Coordinator will manage the collection of supporting medical documentation, application of criteria, manage the physician advisor review process as needed, update the outcome of the review process in EP’s case management system, and manage the member/provider notification of determination process, within CMS/DOH regulatory requirements. The DME Review Coordinator is responsible for making first level determinations, under the support of a Registered Nurse, utilizing Medicare’s National and Local Carrier Policy, Medicare based Interqual criteria for DME, internal Medical Policy, and physician/Medical Director support for medical necessity decisions.
Concentra
Newark, NJ
Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer. * Provides copies of any criteria utilized in a review to a requesting provider in a timely mannerQualificationsEDUCATION/CREDENTIALS: -Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
Concentra
Newark, NJ
Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
Concentra
Newark, NJ
Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
Concentra
Newark, NJ
Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.