Utilization Management Reviewer, RN - Rochester

Only for registered members Rochester, United States

1 month ago

Default job background

Job Description:

This position coordinates integrates and monitors utilization of physical health medical healthcare services for members ensuring compliance with internal external standards set by regulatory accreditation entities Refers appropriate cases to Medical Director for review Refer to and work closely with Case Management to address member needs

  • Performs pre-service concurrent post-service clinical reviews to determine appropriateness of services requested for diagnosis treatment of members medical health conditions applying established clinical review criteria guidelines medical policies contractual benefits as well as State Federal Mandates

Lorem ipsum dolor sit amet
, consectetur adipiscing elit. Nullam tempor vestibulum ex, eget consequat quam pellentesque vel. Etiam congue sed elit nec elementum. Morbi diam metus, rutrum id eleifend ac, porta in lectus. Sed scelerisque a augue et ornare.

Donec lacinia nisi nec odio ultricies imperdiet.
Morbi a dolor dignissim, tristique enim et, semper lacus. Morbi laoreet sollicitudin justo eget eleifend. Donec felis augue, accumsan in dapibus a, mattis sed ligula.

Vestibulum at aliquet erat. Curabitur rhoncus urna vitae quam suscipit
, at pulvinar turpis lacinia. Mauris magna sem, dignissim finibus fermentum ac, placerat at ex. Pellentesque aliquet, lorem pulvinar mollis ornare, orci turpis fermentum urna, non ullamcorper ligula enim a ante. Duis dolor est, consectetur ut sapien lacinia, tempor condimentum purus.
Get full access

Access all high-level positions and get the job of your dreams.



Similar jobs

  • Only for registered members Rochester

    This position is responsible for coordinating and monitoring the utilization of physical health medical and healthcare services for members ensuring compliance with internal and external standards set by regulatory and accreditation entities. · Performs pre-service concurrent and ...

  • Only for registered members Mendon $75 - $85 (USD)

    Larimer Law is seeking a highly motivated and experienced Document Review Project Manager Attorney with experience managing eDiscovery projects to join our team of discovery professionals. · ...

  • Only for registered members Remote

    We are seeking a highly motivated and experienced Document Review Project Manager Attorney with experience managing eDiscovery projects to join our team of discovery professionals. · ...

  • Jackson's Health: Family Health Rochester Full time

    We are looking for a Family Nurse Practitioner or Adult Gerontology NP to join our team at Jackson's Health. The ideal candidate will have experience in primary care and be able to manage their own patient panel following evidence-based guidelines. · Manage patient panels and pro ...

  • Only for registered members Rochester $23.20 - $24.70 (USD)

    ++The Quality Management Specialist works with the Quality Management Department to provide the highest achievable quality of services to the individuals we serve. · ,+The Quality Management Department defines best practices, · identifies strengths in service delivery and provide ...

  • Only for registered members Rochester $23 - $24.70 (USD)

    The Quality Management Specialist works with the Quality Management Department to provide the highest achievable quality of services to the individuals we serve. · Implementing the Quality Management Plan within the agency. · Incident Management to include the review of incident ...

  • Only for registered members Rochester

    The Client Service Specialist is responsible for working collaboratively with other members of the Account Management team to ensure team is equipped to support and consult clients on their employee benefits programs. · Field and manage client, employee, and carrier inquiries. · ...

  • Only for registered members Rochester

    The Client Service Specialist is responsible for working collaboratively with other members of the Account Management team to ensure team is equipped to support and consult clients on their employee benefits programs. · Field and manage client, employee, and carrier inquiries. · ...

  • Only for registered members Rochester $225,200 - $281,500 (USD)

    The Federal Defense Senior Division Manager is an ideal opportunity for an outgoing individual to be responsible for a growing profit center. · ...

  • Only for registered members Rochester

    +As a Health Information Management Technician 2 at Rochester Psychiatric Center, you will work under the direction of a Health Information Management Administrator to supervise Health Information Management Technicians 1 and clerical support staff engaged in health information m ...

  • Only for registered members Rochester

    The Assistant Plant Controller is responsible for accuracy and integrity of all financial information concerning plant activity. · Oversees the financial functions at the plant, including cash and back, accounts receivable, inventory, capital assets, accounts payable, inter-compa ...

  • Only for registered members City of Rochester Full time $60 - $75 (USD)

    Laland Baptiste LLC seeks a senior Construction Project Manager for current or future project opportunities in Rochester, NY. · Project experience in Higher-Education, K-12, or Buildings Rehabilitation required. · ...

  • Only for registered members Rochester $18.65 - $26.11 (USD)

    The University of Rochester School of Nursing is seeking knowledgeable and detail-oriented individuals to serve as Admissions Application Reviewers for our Prelicensure Nursing Programs. The reviewer will play a key role in the School of Nursing's holistic admissions review proce ...

  • Only for registered members Rochester Full time

    The Associate Director of District will assist with the organization and management of all CSE processes, · scheduling of district held meetings, annual reviews, ...

  • Regional Manager

    2 weeks ago

    Only for registered members Rochester $90,000 - $95,000 (USD)

    Regional Managers are responsible to monitor and pro-actively implement fiscal responsibility for each asset under their supervision. · Develop strategic long-term asset plans. · Owning the execution of said plans. · ...

  • Registered Nurse

    23 hours ago

    Corning Center Rochester

    We are hiring a Registered Nurse (RN) Unit Manager in Corning, NY. · Handle all supervisory duties for assigned unit · Mentor less experienced nurses · ...

  • Shift Supervisor

    2 weeks ago

    Only for registered members Rochester

    The Fort Washington Men's Shelter is a 200-bed temporary shelter which Project Renewal manages under a contract with the Department of Homeless Services and the Department of Health and Mental Hygiene. · ...

  • 2026-5834

    1 week ago

    Only for registered members Rochester

    The Store Supervisor ensures the shop meets customer service, inventory management, and paperwork expectations while supervising store personnel. · The position requires providing quality customer service, performing data entry tasks, managing inventory, and supervising store per ...

  • Only for registered members Rochester $65,000 - $75,000 (USD)

    The Credit Analyst II is primarily responsible for underwriting routine to complex commercial loan requests in the Commercial & Industrial (C&I) and Commercial Real Estate (CRE) areas. · This includes analyzing financial information and preparing the credit analyses, ensuring tha ...

  • Only for registered members Rochester

    We are seeking a Senior Process Engineer for Capital Projects to join our client on a Full Time Direct Hire opportunity available in Rochester NY. The role leads process and project engineering execution for small to large chemical process system projects. · ...