RN Utilization Review & Cost Optimization
$26.41 - $61.79 per hourMolina Healthcare of Illinois
Molina Healthcare is seeking a Clinical Support Nurse in Albany, NY to provide critical support in assessing member services and ensuring compliance with clinical guidelines. The ideal candidate will have at least 2 years of experience in acute care or managed care, hold an active RN license, and possess strong problem-solving and communication skills. The position offers a competitive pay range of $26.41 - $61.79 hourly, varying based on location and experience. #J-18808-Ljbffr
$73k - $75k
...to Work® Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review PRIMARY PURPOSE: To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes. ARE YOU AN IDEAL CANDIDATE? We are looking for...SuggestedWork at officeFlexible hours$26.41 - $61.79 per hour
...for clinical member services review assessment processes. Responsible... ...to provide quality and cost-effective member care. Essential... ...Molina care model. Adheres to utilization management (UM) policies and procedures... ...experience. Registered Nurse (RN). License must be active and...SuggestedHourly payWork experience placementLive inWork at office$84.78k - $131.41k
...783.00 - $131,414.00 Responsible for Utilization Management, Quality Screening and Delay... ...Trauma Care and/or previous Utilization Review roles. Qualifications and Ideal Characteristics... ..., displaying a consciousness regarding costs, supplies and department finances....SuggestedShift work$71.61k - $111k
...Range: $71,612.39 - $110,999.20 Responsibilities Responsible for Utilization Management, Quality Screening and Delay Management for... ...based on Departmental standards. While performing utilization review identifies areas for clinical documentation improvement and contacts...SuggestedShift work$30.58 - $55.09 per hour
...flexibility. Position Purpose Routinely reviews more challenging prior... ...team to promote quality and cost effectiveness of medical care.... ...appropriate with healthcare providers, utilization management team, and care... ...state plan and requires NY RN Licensure. Pay Range $30.58 -...SuggestedHourly payFull timePart timeWork at officeRemote workFlexible hours- ...State and Territorial Epidemiologists is seeking a Clinical Review Supervisor to provide operational supervision of clinical staff conducting utilization review activities. This fully remote position requires an RN license and relevant experience in patient care and...Remote work
$40.9 - $41.92 per hour
...Complaint Intake And Triage Nurse Reviewer Working at the direction of the New York State Department of Health... ...New York State Registered Professional Nurse (RN). Two (2) years' experience performing utilization review, medical review, fraud investigations, surveillance...Hourly payWork at officeRelocation package$84.78k - $131.41k
...14.00 Under direction of the Manager of Utilization Management, the Utilization Management Specialist... ...act as a liaison with all payors and review agents, providing required acuity... ...time, displaying a consciousness regarding costs, supplies and department finances....Full timeWork at officeShift work- ...Molina Healthcare in Albany, NY, is seeking a clinical review specialist to ensure medical necessity and appropriate care levels. Candidates... ...least 2 years of clinical nursing experience and hold an active RN license. Responsibilities include reviewing medical claims,...Work at office
$71.61k - $111k
...A healthcare institution in Albany is seeking a Utilization Review Nurse to oversee utilization management and quality screening for patients. The ideal candidate will hold a New York State RN license and possess experience in case management within an acute care setting...Full time$29.05 - $67.97 per hour
...Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing... ...relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in...Hourly payWork experience placementWork at office$29.05 - $67.97 per hour
...Job Description Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level... ...education and experience. • Registered Nurse (RN). License must be active and unrestricted in state...Hourly payWork experience placementWork at office$95 - $96 per hour
...outcomes for people with most complex and costly health conditions. Working across... ...Radiology you will be a key member of the utilization management team. We can offer you a meaningful... ...Be Doing: Serve as the Physician match reviewer in Imaging cases, that do not initially...Full timePart timeWork at officeImmediate start$200k
...Services program office after review of the EDRP application.... ...The Emergency Department RN is responsible and... ...patient driven care that optimizes the patient's experience,... ...Models effective resource utilization through the delegation of cost-effective care delivery....Permanent employmentFull timeTemporary workSeasonal workWork at officeImmediate startRemote workRelocation packageRotating shiftDay shift$60 per hour
...RN Clinical Reviewer - Jericho or Albany, NY Location: Jericho or Albany, NY Employment Type: Full-time, Temp-to-hire (5 days a week) Hourly Rate: $60/hr About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment...Hourly payFull timeTemporary workPrivate practice$2,542 per week
...Registered Nurse (RN) | Operating Room Location: Albany, NY Agency: Cynet Health... ...organizational staff. Willingness to review clinicians with pending state licenses is... ...Electronic Medical Record (EMR) system utilized is Epic. Scrub colors and dress code will...Full timeContract workLocal areaShift work- ...provider in Albany is seeking a dedicated Registered Nurse for the Care Management/Social Work department. The role involves conducting utilization management and collaborating with healthcare teams to improve patient care. The ideal candidate holds a current New York State...
$71.61k - $111k
...A healthcare organization in Albany is seeking a Registered Nurse to manage Utilization and Quality Screening for patients. The ideal candidate will have a Bachelor's degree and a minimum of three years clinical experience, preferably in case management. Responsibilities...$40.39 - $60.96 per hour
...health needs and goals. Utilizing skilled communication,... ...promotes high-quality, cost-effective outcomes. Key... ...barriers to care, and optimizing resource allocation while... ...Registered Nurse (RN) license in state of practice... ...HiredScore assists in reviewing applications, all final...Hourly payWork at office$62.4k - $96.08k
...coach, coordinate care and review treatment options, through collaboration... ...interventions to ensure optimal and cost‑effective health outcomes.... .... Examples may include Utilization Management, Quality, Behavioral... .... All Levels Active NYS RN license required with three...Work at officeRemote workFlexible hours$87.6k - $97k
...a Complex Care Case Manager, RN for Workers Compensation managed... ...safe return to work or best optimal level of function through... ...responsibilities may include utilization review, pharmacy oversight and care... ...while maximizing quality and cost-effectiveness of care including...Work experience placementWork at officeFlexible hours$2,678 per week
...Registered Nurse (RN) | Cardiology Location: Albany, NY Agency: Seven Healthcare... ...-quality cardiac care to patients Utilize Epic systems for patient records and... ...with a multidisciplinary team to ensure optimal patient outcomes Conduct assessments...Weekly payFull timeImmediate startFlexible hoursShift workNight shift$2,678 per week
...Registered Nurse (RN) | Cardiology Location: Albany, NY Agency: Seven Healthcare... ...-quality cardiac care to patients Utilize Epic systems for patient records and... ...with a multidisciplinary team to ensure optimal patient outcomes Conduct assessments...Weekly payFull timeImmediate startFlexible hoursShift workNight shift$94.96k - $147.18k
...procedures, and systems in compliance with regulatory standards. Utilizes strong presentation skills in a manner that is both engaging... ...of clinical research. Keeps current in field by reviewing relevant literature, attending workshops and seminars, networking...Shift work- ...Creative Solutions Services, LLC is seeking a Dentist in Albany, NY, to review dental prior approval requests and communicate with dental offices. Candidates must have a valid dental license and knowledge of New York State Medicaid. Good communication skills are essential...Monday to Friday
$41.25 - $52.77 per hour
...Type Full time Shift Day Shift Description RN – Medical Oncology If you are looking for... ...the responsibility and accountability to utilize the nursing process to diagnose and treat... ...and documents in electronic medical record. Review and update medication list to ensure accurate...Hourly payFull timeWork at officeLocal areaMonday to FridayShift workDay shift$200k
...Services program office after review of the EDRP application... ...Registered Nurse (RN) is responsible for... ...improvement and enhance outcomes utilization. This nurse integrates... ...driven care that optimizes the patient's... ...through the delegation of cost-effective care delivery...Permanent employmentTemporary workSeasonal workWork at officeImmediate startRemote workRelocation packageMonday to FridayWeekend workDay shiftAfternoon shift$200k
...Services program office after review of the EDRP application... ...– BSN, 2 years of RN experience, 1–2 years... ...improvement and enhance outcomes utilization. This nurse integrates... ...driven care that optimizes the patient’s... ...through the delegation of cost‑effective care delivery...Permanent employmentTemporary workWork at officeImmediate startRemote workRelocation packageMonday to FridayWeekend workDay shiftAfternoon shift$200k
...Services program office after review of the EDRP application... ...: BSN, 2 years of RN experience, 1–2 years... ...improvement to enhance outcomes utilization. Integrates outpatient... ...‑driven care that optimizes patient experience,... ...through the delegation of cost‑effective care delivery...Permanent employmentTemporary workWork at officeRemote workRelocation packageMonday to FridayWeekend workDay shiftAfternoon shift- ...support patients and families to optimally manage their health care,... ...documents results in EHR Performs review and triage of incoming test... ...necessary Facilitates the utilization of resources to meet patient... ...is required NYS current RN licensure to practice...Work at office
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