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Utilization Review Nurse Jobs in New York

7 jobs

Utilization Review Nurse At Oscar, we work hard to provide the kind of health insurance we would want for ourselves. This means that we get to be creative and to build an excellent health insurer from the ground up. We're looking for experienced clinicians to join the fast-growing Utilization Management team in our NYC headquarters. We're working to bring a new level of service to utilization revi...
Licensed Utilization Review Nurse I (Call Center Nurse) 121975 Medical-550298 Primary Location :NY-Albany Description The Licensed Utilization Review Nurse is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information to preauthorize services, assess medical necessity, out of network services,...
Description The Licensed Utilization Review Nurse is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information to preauthorize services, assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, p...
Facilitates a process of assessment, planning and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost effective care. Validates appropriate level of care (severity of illness), efficient and effective care delivery (intensity of services) and safe discharge to the next appropriate level of care. Conducts admiss...
Facilitates a process of assessment, planning and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost effective care. Validates appropriate level of care (severity of illness), efficient and effective care delivery (intensity of services) and safe discharge to the next appropriate level of care. Conducts admiss...
The Utilization Review Nurse (URN) performs clinical reviews to determine the medical necessity of requested services. The URN obtains clinical information and utilizes IHA policy and/or defined criteria to determine medical necessity, and if necessary, will consult with the Associate Medical Director and/or Medical Director for all requests that do not meet criteria or IHA policy. The URN will a...
Description: As a Utilization Review Nurse you will review and coordinate prospective, concurrent and retrospective activities related to utilization. Monitor documentations for accuracy and clinical compliance. Organize and coordinate activities within the organization in accordance with standards of State and Federal regulations; and in accordance with accreditation and other guidelines. RESPONS...