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Sunrise Senior Living
New York
**_Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 7th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of._** **COMMUNITY NAME** The Apsley **Job ID** 2024-209649 **JOB OVERVIEW** **You're invited to our Hiring Event a
Job Source: Sunrise Senior LivingSunrise Senior Living
West Orange
**_Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 7th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of._** **Job ID** 2024-212426 **JOB OVERVIEW** **_"It makes me feel good knowing that we make the residents’ lives
Job Source: Sunrise Senior LivingRWJBarnabas Health
Belleville
RNReq #:0000153076 Category:Nursing Status:Part-Time Shift:Day Facility:Clara Maass Medical Center Department:Discharge Hospitality Suite Location: Clara Maass Medical Center, 1 CLARA MAASS DRIVE, BELLEVILLE, NJ 07109 Job Overview: Located in Belleville, Clara Maass Medical Center is a facility of RWJBarnabas Health and provides a complete continuu
Job Source: RWJBarnabas HealthSunrise Senior Living
Florham Park
**_Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 7th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of._** **COMMUNITY NAME** Brighton Gardens of Florham Park **Job ID** 2024-213177 **JOB OVERVIEW** **_"It makes me
Job Source: Sunrise Senior LivingSunrise Senior Living
New York
**_Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 7th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of._** **Job ID** 2024-212930 **JOB OVERVIEW** **_"It makes me feel good knowing that we make the residents’ lives
Job Source: Sunrise Senior LivingSunrise Senior Living
Brooklyn
**_Sunrise Senior Living was again certified as a Great Place to Work® by Activated Insights. This is the 7th time Sunrise has received this top culture and workplace designation, highlighting the special place Sunrise is to be a part of._** **Job ID** 2024-204414 **JOB OVERVIEW** **_"It makes me feel good knowing that we make the residents’ lives
Job Source: Sunrise Senior LivingRWJBarnabas Health
Belleville
RNReq #:0000157402 Category:Nursing Status:Full-Time Shift:Night Facility:Clara Maass Medical Center Department:Nursing Float Pool Location: Clara Maass Medical Center, 1 CLARA MAASS DRIVE, BELLEVILLE, NJ 07109 Job Overview: Located in Belleville, Clara Maass Medical Center is a facility of RWJBarnabas Health and provides a complete continuum of ca
Job Source: RWJBarnabas HealthFresenius Medical Center
Queens
**POSITION FEATURES:** In Center - Home Therapies position Paid one on one training and education provided Empower, engage and train dialysis patients on peritoneal and home hemodialysis using state of the art training programs and equipment Primarily works in the clinic setting and conducts initial home visits with another staff member presen
Job Source: Fresenius Medical CenterStaten Island
UM RN
75 Vanderbilt Ave, Staten Island, NY 10304, USA
Req #11805
Monday, June 3, 2024
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
JOB SUMMARY:
The Utilization Management nurse works within a multidisciplinary team to help identify and manage members who are in need of additional care or support in their home to improve their quality of life. The Utilization Management nurse will assess and process all authorization requests to determine medical necessity to ensure all care services, member education, and preventative interventions are maintained.
PRIMARY RESPONSIBILITIES:
+ Authorization of medically necessary services in coordination with the care management department. Review of care management documentation and outcomes evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
+ Ensures that the services required for the plan of care is met in partnership with the person centric process which may include his/her significant other, primary caregiver, the primary and attending physicians, and various other providers and support involved in the member’s care.
+ Provides utilization review for preauthorization, concurrent and discharge reviews and post service review
+ Apply medical necessity guidelines based on appropriate criteria
+ Utilizes knowledge of community resources and the member’s benefit structure
+ Interacts with providers and facilities in a professional, respectful manner
+ Recognizes quality of care issues and escalates the issues appropriately
+ Have a knowledge of the Appeals and Grievances process
+ Assists members with the coordination of services from various settings as appropriate
+ Complies with all CPHL’s standards for documentation
+ Participates in case rounds as a member of the Integrated Care Team
+ Participates in on call scheduling
+ Participates in other meetings as requested
+ Participates in quality improvement initiatives
+ Other duties as assigned
EDUCATION AND EXPERIENCE:
Type of Experience
Required:
+ Active and unrestricted NYS RN license
+ Minimum 2 years utilization management experience
+ Strong written and verbal communication skills
+ Ability to travel within assigned area
Preferred:
+ Bachelor of Science in Nursing
+ CCM certification
+ Knowledge of Milliman or InterQual criteria
Preferred:
+ Experience working within a managed care environment
Specific Technical Skills
Preferred: Computer proficiency
SCOPE INFORMATION
# Direct Reports: 0
PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required
Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.
Other details
+ Pay Type Salary
+ Min Hiring Rate $90,000.00
+ Max Hiring Rate $98,000.00
Apply Now
+ 75 Vanderbilt Ave, Staten Island, NY 10304, USA
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