NewTravel Utilization Review RN - $2,724 per week Healthcare SupportTravel Utilization Review RN - $2,724 per weekNyack, NYYour travel team will include a designated credentialing expert to help you navigate every step of the on-boarding process, a payroll specialist who you can communicate with directly, and a skilled recruiter who takes the time to understand your needs and works hard to find the right position for you. Not only does HealthCare Support reimburse for relocation and travel costs on your first check, but we also offer license and certification reimbursements required for your assignments so that you can focus on building your career.
NewTravel Nurse RN - Utilization Review - $2,724 per week Healthcare SupportTravel Nurse RN - Utilization Review - $2,724 per weekNyack, NYYour travel team will include a designated credentialing expert to help you navigate every step of the on-boarding process, a payroll specialist who you can communicate with directly, and a skilled recruiter who takes the time to understand your needs and works hard to find the right position for you. Not only does HealthCare Support reimburse for relocation and travel costs on your first check, but we also offer license and certification reimbursements required for your assignments so that you can focus on building your career.
NewTravel Nurse RN - Utilization Review - $3,017 to $3,112 per week in West Bronx, NY TravelNurseSourceTravel Nurse RN - Utilization Review - $3,017 to $3,112 per week in West Bronx, NYWest Bronx, NY$3,017–$3,112As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
NewRN Homecare Team Leader - Queens NY JobotRN Homecare Team Leader - Queens NYQueens, NY$106,000–$125,300 / yearThis 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.
NewMLTC RN Case Manager- Bilingual Spanish with 20K Sign on Bonus) JobotMLTC RN Case Manager- Bilingual Spanish with 20K Sign on Bonus)Queens, NY$105,000–$115,000 / yearInformation 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.
NewHospital RN Case Manager JobotHospital RN Case ManagerWest Nyack, NY$125,000–$135,000 / yearThis 200 bed hospital has a state-of-the-art Ambulatory Surgery Center, Level 3 Trauma Center / ER with a dedicated Pediatric Emergency Unit, an Express Care area for non-life-threatening emergency cases and cardiac catheterization lab, and is recognized for the exceptional care in cancer surgery, joint replacement, cardiac care, treatment of stroke, breast imaging, sleep medicine, diabetes education and treatment of substance use disorders. 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.
NewMLTC Case Management RN JobotMLTC Case Management RNNew York, NY$115,000–$120,000 / yearInformation 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.
NewHomecare Field RN with 15K Sign on bonus - Brooklyn NY JobotHomecare Field RN with 15K Sign on bonus - Brooklyn NYNew York, NY$105,000–$110,000 / yearInformation 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.
NewHomecare Field RN with 15K Sign on Bonus - Queens NY JobotHomecare Field RN with 15K Sign on Bonus - Queens NYQueens, NY$105,000–$110,000 / yearInformation 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.
NewHomecare Field RN with 15K Sign on Bonus - Bronx NY JobotHomecare Field RN with 15K Sign on Bonus - Bronx NYNew York, NY$105,000–$110,000 / yearInformation 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.
NewVisiting Registered Nurse - 15K Sign on Bonus - Westchester NY JobotVisiting Registered Nurse - 15K Sign on Bonus - Westchester NYYonkers, NY$105,000–$125,000 / yearInformation 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.
NewHomecare Field RN with 15K Sign on Bonus - Manhattan NY JobotHomecare Field RN with 15K Sign on Bonus - Manhattan NYNew York, NY$105,000–$110,000 / yearInformation 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.
MDS Specialist RN Care-OneMDS Specialist RNWhippany, NJ$83,000–$120,000 / yearUtilization Review & Triple-Check Coordination: Lead the weekly Utilization Review (UR) and Triple-Check meetings, collaborating with therapy, nursing, and the business office to validate medical necessity, track managed care authorizations, and ensure accurate billing alignment prior to transmission. Lead MDS/Clinical Reimbursement Coordinator will be responsible for, but not limited to: MDS/RAI Process Leadership: Direct the timely and accurate completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in strict compliance with CMS regulations.
NewTravel Hospice RN - $2,599 per week Prime StaffingTravel Hospice RN - $2,599 per weekSummit, NJSchedule Notes:Days per week: 5Shift: 8a-4pEvery other weekend with comp days during the weekFloat: Yes to different counties according to needSkills: Required Skills & Experience:-Must have two (2) years of experience as RN in home hospice environment.-Experience using an EMR, excellent critical thinking and communication skills. Preferred Certifications & Licensure:-N/A Job Qualifications/Experience:Current New Jersey RN LicenseExperience using an EMR, excellent critical thinking and communication skillsJob Category: Clinical - Nursing - Travel Guaranteed Hours: Yes Contract Weeks:146.
NewTravel RN Case Manager - $2,871 per week GLC On-The-GoTravel RN Case Manager - $2,871 per weekBronx, NY$2,584–$2,610 / weekWe specialize in connecting travel nurses and allied healthcare professionals like you with opportunities in acute care, long-term care, behavioral health, and allied fields across the U.S. Caseload: Floors typically have 33-40 patients; most floors are split with 1 Case Manager & 1 Social Worker; caseload: 17-25 patients.
Registered Nurse Float – Critical Care Yale New Haven HealthRegistered Nurse Float – Critical CareWhite Plains, NYDevelops, 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.
Registered Nurse - ICU Yale New Haven HealthRegistered Nurse - ICUStamford, CTDevelops, 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.
RN - Psychiatric Services / Psych Unit Yale New Haven HealthRN - Psychiatric Services / Psych UnitWhite Plains, NYUnder the supervision of the Nurse Manager or Clinical Coordinator, the Registered Nurse (RN) provides comprehensive, patient-centered care across a diverse behavioral health population, we have open roles, and various shifts open in Adolescent Psychiatry, General Adult, Geriatric Psychiatry, Mood Disorders, and Transitional Youth . This role includes supervising non-RN staff, coordinating patient care activities, and serving in a charge nurse capacity when assigned, including delegation and oversight of unit operations.
Registered Nurse Critical Care (ICU) – Float Pool Yale New Haven HealthRegistered Nurse Critical Care (ICU) – Float PoolYonkers, NYDevelops, 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.
Mental Health RN Yale New Haven HealthMental Health RNWhite Plains, NYUnder the supervision of the Nurse Manager or Clinical Coordinator, the Registered Nurse (RN) provides comprehensive, patient-centered care across a diverse behavioral health population, we have open roles, and various shifts open in Adolescent Psychiatry, General Adult, Geriatric Psychiatry, Mood Disorders, and Transitional Youth . This role includes supervising non-RN staff, coordinating patient care activities, and serving in a charge nurse capacity when assigned, including delegation and oversight of unit operations.
RN Float Pool – Critical Care Yale New Haven HealthRN Float Pool – Critical CareWhite Plains, NYDevelops, 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.
Registered Nurse – ICU Float Unit Yale New Haven HealthRegistered Nurse – ICU Float UnitWhite Plains, NYDevelops, 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.
RN General Medicine - Immediate Hiring Yale New Haven HealthRN General Medicine - Immediate HiringWhite Plains, NYDevelops, 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.
Registered Nurse (RN), Float Critical Care / ICU Yale New Haven HealthRegistered Nurse (RN), Float Critical Care / ICUYonkers, NYDevelops, 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.
RN - Behavioral Medicine / Behavioral Services Yale New Haven HealthRN - Behavioral Medicine / Behavioral ServicesWhite Plains, NYUnder the supervision of the Nurse Manager or Clinical Coordinator, the Registered Nurse (RN) provides comprehensive, patient-centered care across a diverse behavioral health population, we have open roles, and various shifts open in Adolescent Psychiatry, General Adult, Geriatric Psychiatry, Mood Disorders, and Transitional Youth . This role includes supervising non-RN staff, coordinating patient care activities, and serving in a charge nurse capacity when assigned, including delegation and oversight of unit operations.
RN - Childrens Neonatal ICU Yale New Haven HealthRN - Childrens Neonatal ICUStamford, CTDevelops, 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.
Behavioral Health RN Yale New Haven HealthBehavioral Health RNWhite Plains, NYUnder the supervision of the Nurse Manager or Clinical Coordinator, the Registered Nurse (RN) provides comprehensive, patient-centered care across a diverse behavioral health population, we have open roles, and various shifts open in Adolescent Psychiatry, General Adult, Geriatric Psychiatry, Mood Disorders, and Transitional Youth . This role includes supervising non-RN staff, coordinating patient care activities, and serving in a charge nurse capacity when assigned, including delegation and oversight of unit operations.
RN - General Medicine Yale New Haven HealthRN - General MedicineWhite Plains, NYDevelops, 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.
RN - MICU Yale New Haven HealthRN - MICUStamford, CTDevelops, 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.
RN - Acute Care Medicine Yale New Haven HealthRN - Acute Care MedicineWhite Plains, NYDevelops, 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.
RN Clinical Reviewer Greenlife Healthcare StaffingRN Clinical ReviewerJericho, NYThis individual will work under the direction of the supervisor of the team performing clinical reviews and abstractions of assigned cases related to a maternal death or to an adverse event that occurred during an outpatient surgical procedure. Impactful Work: Contribute to a mission-driven organization dedicated to improving patient outcomes by identifying and analyzing critical events in maternal care and outpatient surgical procedures.
Registered Nurse Clinical Reviewer / IDR Greenlife Healthcare StaffingRegistered Nurse Clinical Reviewer / IDRJericho, NYGreenlife Healthcare Staffing is currently seeking a Registered Nurse Clinical Reviewer / IDR to fill an opening with a Non-profit organization located in Jericho, New York. This includes chart screens, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations.
Registered Nurse - Nursing Home Surveyor/Complaint Investigator Greenlife Healthcare StaffingRegistered Nurse - Nursing Home Surveyor/Complaint InvestigatorNew York, NYWe are seeking a dedicated and experienced Registered Nurse - Nursing Home Surveyor/Complaint Investigator to join our team in New York City, NY (Bronx, Kings, Richmond, Manhattan, and Queens). This role is a temporary-to-permanent position that involves conducting surveys, complaint investigations, and surveillance activities at nursing homes to ensure compliance with Federal and State regulations.
HVC Cardiac Cath Lab Nurse Yale New Haven HealthHVC Cardiac Cath Lab NurseEaston, CTHVC Cardiac Cath Lab Nurse at Yale New Haven Health summary: The HVC Cardiac Cath Lab Nurse provides specialized nursing care to patients in a cardiac catheterization lab, including assessment, planning, implementation, and evaluation of individualized care plans. Keywords: Cardiac Cath Lab Nurse, Registered Nurse, Neuro Patient Care, Airway Management, Charge Nurse, Patient Assessment, Care Plan Development, Ventilator Care, BLS Certified, Healthcare Team Collaboration.
NewLicense Behavioral Health Clinician VNS HealthLicense Behavioral Health ClinicianBrooklyn, NY$66,300–$79,800Minimum 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 requiredEffective oral/written/interpersonal communication skills requiredBilingual skills may be required as determined by operational needs. For Wellness WeCare Program: LMSW, LCSW, LMHC, RN or Certified Rehabilitation Counselor requiredFor CCBHC Program: LMSW, LCSW, LMHC, or Marriage and Family Therapist required AND CASAC certification requiredFor all others: LMSW, LCSW, LMHC, or Marriage and Family Therapist required.
Utilization Review Nurse Oscar Health IncUtilization Review NurseNYRemote$35–$45.94 / hourWork Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. Requirements: Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
Utilization Review Coordinator, (NY HELPS), New York City Children's Center - Bronx Campus, P26503 New York State Thruway AuthorityUtilization Review Coordinator, (NY HELPS), New York City Children's Center - Bronx Campus, P26503NY$70,579–$89,645 / yearAll OMH employees receive a generous benefits package including: • NYS medical, dental, & vision insurance • Access to tuition assistance programs • Excellent opportunities for advancement & professional growth • Paid time off - 13 paid vacation days in the first year, 5 paid personal days, 13 paid holidays, & paid sick leave • NYS Retirement programs. Duties Description New York City Children's Center - Bronx Campus is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency of psychiatric and medical services provided to individual diagnosed with mental illness.
Utilization Review Coordinator (NY HELPS), Manhattan Psychiatric Center, P27097 New York State Thruway AuthorityUtilization Review Coordinator (NY HELPS), Manhattan Psychiatric Center, P27097New York, NY$70,579–$89,645 / yearNotes: In order to be eligible for appointment and to maintain employment, you cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally assisted program). The Mission of the New York State Office of Mental Health (OMH) is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances.
Utilization Management, Registered Nurse RN Clover Health Investments CorpUtilization Management, Registered Nurse RNNYRemote$90,000–$106,000 / yearAs a Utilization Management, Registered Nurse (RN), you will: Perform medical necessity reviews for prior authorization and concurrent review across acute inpatient, post-acute (SNF, IRF, LTACH) and outpatient services Apply CMS Medicare guidelines, NCD/LCD policies, and MCG criteria to support determinations Manage cases end-to-end from prior authorization through concurrent review and discharge Collaborate with providers and facilities to obtain clinical information and support care coordination Ensure compliance with CMS turnaround times and regulatory requirements Participate in Quality Assurance (QA) activities, including case audits and peer reviews to ensure accuracy and consistency in decision-making Have strong personal accountability, responsibility and independent decision-making abilities. Additional Perks: Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities Reimbursement for office setup expenses Monthly cell phone & internet stipend Remote-first culture, enabling collaboration with global teams Paid parental leave for all new parents * And much more!
NewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantNY$26.01–$62.32 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Clinical Review & Correspondence RN Cohere Health Technologies LLCClinical Review & Correspondence RNNYRemote$31–$35 / hourBy unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. Opportunity Overview: The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications.
NewSenior Clinical Review Nurse - Prior Authorization Centene Corporation GroupSenior Clinical Review Nurse - Prior AuthorizationNY$30.58–$55.09 / hourCollaborates with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care. Provides education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members.
Utilization Management Manager HealthfirstUtilization Management ManagerNY$116,800–$168,810 / yearDevelops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisions. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798.
NewUtilization Specialist, Case Management Memorial Sloan Kettering Cancer CenterUtilization Specialist, Case ManagementNew York, NY$77,100–$119,400 / yearInformed by basic research done at our Sloan Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of cancer as a disease and improving the ability to prevent, diagnose, and treat it. Document clinical reviews, payer communications, treatment delays, avoidable days, and other case management activities in accordance with departmental and regulatory requirements.
Care Manager - Utilization Management (Must Have UAS Experience) Metroplus Health Plan IncCare Manager - Utilization Management (Must Have UAS Experience)NYRemoteThe Care Manager, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.
Utilization Management (UM) Clinical Team Lead Metroplus Health Plan IncUtilization Management (UM) Clinical Team LeadNew York, NYMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. Position Overview: The Clinical Team Lead, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient.