RN Utilization Management Reviewer: LTSS & Duals
Capital District Physicians Health Plan Inc
Capital District Physicians Health Plan Inc is seeking a Utilization Management professional to coordinate, integrate, and monitor health services for members. The role supports case management, collaborates with providers, and ensures compliance with state and federal mandates. The position involves on-call rotation and may include additional hours to meet departmental needs. Strong communication and multitasking skills are essential for delivering efficient member care. #J-18808-Ljbffr Capital District Physicians Health Plan Inc
- ...integrating, and monitoring the utilization of physical health (PH) medical and... ...to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates... ...Associates degree and active NYS RN license required. Bachelors...SuggestedContract workWork at officeRemote work
$32.01 - $68.55 per hour
...and every day. Position Summary This Utilization Manager position is with Aetna's Long-Term Services and Supports (LTSS) team and is a fully remote role. Candidates... ...MCG rules and medical necessity guidelines to review service requests, working closely with...SuggestedHourly payFull timeLocal areaRemote work10 hours per weekFlexible hours- Molina Healthcare, Inc. is seeking a registered nurse in New York to support care management and LTSS activities. You will collaborate with a multidisciplinary team to coordinate member care across the continuum and help members progress toward outcomes. Responsibilities...Suggested
- Intermountain Health is seeking an RN Utilization Review Care Management I for flexible, enterprise-wide coverage, including shifts across Peaks/Canyons/Desert regions. The role emphasizes utilization review, clinical decision-making, and collaboration with providers and...SuggestedRemote jobPart timeFlexible hoursShift workWeekend work2 days per week
$41.2 - $62.17 per hour
Fully Remote St. Marys Regional Hospital Part time R189124 Job Description The RN Utilization Review Care Management I leverages clinical expertise and critical thinking to perform utilization review care management screenings, assessments, and evaluations, with a strong...SuggestedHourly payPart timeReliefWork at officeRemote workFlexible hoursShift workWeekend work2 days per week$77.08k - $119.47k
...Department/Unit: Care Management/Social Work Work Shift: Day (United States of America) Salary... ...77,075.00 - $119,466.00 Responsible for Utilization Management, Quality Screening and Delay... ...with skills applicable to utilization review process. Excellent written and verbal communication...Remote workShift work- Eddy Visiting Nurse and Rehab Association is seeking a Registered Nurse (RN) to join our Home Care team as a CODER/OASIS Reviewer. This per diem, part-time, or full-time role codes and completes OASIS reviews on SOC, ROC, and RECERTS, aligning with Coding and OASIS guidelines...Daily paidFull timePart timeFlexible hours
- CGS Federal is seeking a mid-level Hmong Chinese Document Reviewer to join the in-house legal team. You will support eDiscovery activities, workflow management, and a dynamic litigation portfolio. Responsibilities include drafting and researching post-conviction and direct...
- Eddy Visiting Nurse and Rehab Association in Troy, NY is seeking a RN CODER/OASIS Reviewer to join our Home Care team. Per diem, part-time or full-time options with a day shift are available. You will code and review OASIS records on SOC, ROC, and RECERTS, ensuring compliance...Daily paidFull timePart timeFlexible hoursDay shift
$32.01 - $68.55 per hour
...person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends,... ...care setting Must have active current and unrestricted RN licensure in state of residence Utilization Management is a...Remote jobHourly payFull timeTemporary workWork at officeLocal areaWork from homeShift workAfternoon shift- Hmong Chinese Language Document Reviewer Employment Type: Full Time, Mid-Level Department... ...including eDiscovery activities, workflow management, and litigation support. CGS is seeking... ...of written documents and materials utilizing a wide range of office software applications...Full timeWork at officeFlexible hours
$41.2 - $62.17 per hour
...Hospital Part time R178611 Job Description: The RN Hospital Care Manager I delivers comprehensive care management services to... ...Certification Demonstrated experience in case management, utilization review, value-based care, and/or discharge planning. Basic...Hourly payPart timeRemote workShift workWeekend work$20 per hour
...This is a 2+ month contract opportunity. Pay range: $20.00 per hour This is an administrative role focused on physical file management. The position requires organizing, boxing, and logging files according to retention policies, as well as preparing files for shredding...Hourly payPermanent employmentContract work$4,880 per week
...Nurse Manager The Manager has 24-hour accountability for the effective... ...organizational goals. Utilizes motivational dynamics to maintain... ...and quality coordinators to review outcomes and establish targets... .... Qualifications: RN New York License Prior CVOR...Interim roleLocal areaImmediate startShift work$20 - $30 per hour
...you should expect either on any given day. •Annotate — Read a trajectory nobody has looked at yet and judge it step by step. • Review — Take an existing annotation, written by our AI tooling or another person, and confirm, correct, or reject it. TASKS YOU'LL SEE...Hourly payFull timeContract workImmediate startRemote work$65k - $85k
...Registered Nurse (RN) Care Coordinator The Registered Nurse (RN) Care Coordinator... ...communication and critical thinking skills, self-management expertise along with outstanding customer... ...health. Specific Responsibilities: Utilizes evidence based practice standards, PCMH...Local area- ...Case Management Program Coordinator Conducts case management program... ..., coach, coordinate care and review treatment options, through... ...services. Examples may include: Utilization Management, Quality,... ...degree preferred. Active NYS RN or Registered Dietician or Physical...Work at office
$125k - $250k
Our client is a public accounting firm. They seek a Tax Review to join their Manhattan, NY office.ResponsibilitiesEvaluate federal, state... ...with external advisors such as attorneys and investment managers to implement integrated tax strategiesMentor junior tax professionals...Work at officeLocal area$72.7k
...responsible for providing comprehensive case management services to members, ensuring quality,... ..., resolving and preventing improper utilization of member benefits. ESSENTIAL RESPONSIBILITIES... ...Required Current State of PA RN licensure OR Current multi-state licensure...Remote jobContract workFor contractorsWork at officeLocal area$24.76 - $38.7 per hour
...Data Reviewer At Regeneron, we use science and innovation to develop life-changing medicines for people with serious diseases. Regeneron... ...performed on‑site. Please speak with your recruiter and hiring manager for more information about on‑site expectations for your role...Hourly payWorldwide$40.38 - $43.46 per hour
...Computer proficiency with the ability to learn and understand new review programs and monitoring tools. Able to travel to on-site... ...EDUCATION & EXPERIENCE: ~ Registered Professional Nurse (RN). Currently licensed and registered in New York State, required....Bi-weekly payHourly payWork at officeRemote workRelocation package- ...Summary: The Infusion Lead RN will direct patient care, provide clinical oversight, along with operational support in an outpatient... ...medical records, MS Office Demonstrates strong time management skills and organizational skills. Knowledge of HIPAA and OSHA...Full timeRelocation package
- ...Troy Center is hiring a Weekend Registered Nurse (RN) Supervisor in Troy, NY. Duties: Complete resident care requirements by scheduling... ...confidence by monitoring confidential information processing Manage documentation of resident care services Promote a cooperative relationship...Weekend work
$2,791 per week
...Registered Nurse (RN) | Cardiac Catheterization Lab Location: Albany, NY Agency: FlexCare Pay: $2,791 per week Shift... ...leader in travel nursing, allied health, and therapy talent management solutions for top healthcare facilities throughout the U.S....Full timeContract workImmediate startShift work$2,776 per week
...Registered Nurse (RN) | Coronary Care Location: Albany, NY Agency: Revolution Healthcare Services Pay: $2,776 per week... ...experience; MICU experience also considered Epic EMR system utilized throughout the facility Full-time commitment with 48-hour work...Permanent employmentFull timeContract workReliefLocal areaImmediate startShift workNight shift$26.25 - $30 per hour
...The Analytical Chemistry Data Reviewer is responsible for reviewing GMP laboratory data and documentation to ensure compliance with... ...Additional Requirements Ability to learn new processes and manage multiple tasks simultaneously Ability to follow instructions...Hourly payFull timeRemote workMonday to FridayDay shift- Regeneron Pharmaceuticals, Inc. is seeking a Quality Reviewer / Batch Release Specialist to verify batch records and CoAs for clinical and commercial products. You will work with regulatory leads, global teams, and distribution compliance to ensure product quality and...Remote jobContract workFlexible hours
$2,775 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Albany, NY Agency: Revolution Healthcare Services Pay: $2,77... ...Stepdown unit with critical care environment Epic EMR system utilized throughout the facility Rotation includes 5-bed Med-Surg experience...Permanent employmentFull timeContract workReliefLocal areaImmediate startShift workNight shift$2,812 per week
...Registered Nurse (RN) | Neuro Location: Albany, NY Agency: Seven Healthcare Pay: $2,812 per week Shift Information... ...Neuro-Progressive competency exams and skill checklists Utilize Epic EMR system effectively Requirements of the RN - Neurology...Weekly payFull timeImmediate startFlexible hoursShift workNight shift$2,775 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Albany, NY Agency: Revolution Healthcare Services Pay: $2,77... ...progressive care in a dedicated stepdown environment Epic EMR system utilized facility-wide Hands-on neuro patient population requiring...Full timeContract workLocal areaShift workNight shift
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