Utilization Review Nursing: Ensuring Medical Necessity and Efficiency

A company is looking for a UM Review Nurse to assist its Health Services Department. Key Responsibilities Complete prior authorization and retrospective review of medical services Refer cases to Medical Directors as necessary Maintain knowledge of regulations and comply with internal policies R

Our client, a respected community hospital in Brooklyn, is seeking a Utilization Review & Quality Improvement RN to join its clinical quality team. This position offers the opportunity to make a meaningful impact on patient care through utilization...

1152708_RR00112970 Job ID: 1152708_RR00112970 NYU Langone Hospital—Brooklyn is a full-service teaching hospital and Level I trauma center located in Sunset Park, Brooklyn. The hospital is central to a comprehensive network of affiliated...

Key Responsibilities: Review prior authorization requests for medical necessity and collaborate with Medical Directors as needed Utilize evidence-based criteria and governmental policies for medical necessity reviews and manage claims disputes Coordinate transitions of care and referrals to Care

The Travel Nurse RN - Case Manager, Utilization Review role involves providing high-quality nursing care while managing cases for patients during a 13-week travel assignment. Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Bronx, New York.

Key Responsibilities Review and document prior authorization and appeals requests, along with member case history Analyze trends and recommend revisions to medical policies and utilization management based on case reviews Interface with members, providers, and internal departments to ensure effe

$15,000 Sign on Bonus or Student Loan Assistance In this field position you will perform initial physical and psychosocial assessments of potential hospice patients in order to develop individualized plans of care, goals,...

Position Overview: The primary function of the Clinical Quality Reviewer - Seasonal is to conduct audit of medical charts for compliance with HEDIS, QARR, Medicare Advantage Star measure specifications. This position will be...

Precision, Compassion, Results—Join the Team That Delivers Set your sights on a career with NewYork-Presbyterian Queens and play an integral role in our goal to provide the highest level of complex and innovative surgical care,...

Job Title : Clinical Quality Reviewer - Hybrid Location : New York, NY 10004 Duration : 7 Months Education : High School/GED Shift Details :...

Overview VNS Health Home Care RNs redefine the standard of patient-centered care for New Yorkers while keeping them out of the crowded hospital system so they can heal and age where they are most comfortable- in their homes...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance...

Compass Healthcare Consulting & Placement is conducting a search for an experienced RN Administrator for Admissions, Intake & Outreach for a Hospital located in the Bronx, NY. New York State Registered Nurse and Masters Degree in Nursing is...

Posting Date 11/06/2025 26 thru 48 Brighton11th Street, Brooklyn, New York, 11235, United States of America DaVita is seeking a Clinical Coordinator who is looking to give life in an outpatient dialysis center.

Job Title: RN – Nurse Educator (Labor & Delivery) Location: Brooklyn, NY 11206 We are urgently hiring an experienced RN Nurse Educator – Labor & Delivery for a 13-week...

Overview Conducts comprehensive assessment of member UAS-NY for potential new members and existing members' conditions clinical, environmental, and social to establish an individual plan of care needed to...

Renewal Memory Partners is an innovative homecare provider specializing in dementia. We uniquely combine a mission-driven approach with a concierge client experience. Our clients include many of New York's most accomplished...

Position Summary To coordinate and facilitate patient care through the Valley Hospital Health Care System as it relates to a multidisciplinary approach to patient care and utilization of...

Location: Brooklyn, NY 11225 Schedule: Flexible, 35 hours per week Role Type: 13-week contract with potential for extension and/or hire Compensation: $45-$48/hr.

Chief Nursing Officer Compensation: $300k- $350k per year Job Type: Full-time, Monday–Friday A major New York City health system is seeking a Chief Nurse...