Advanced Search
Title
Company
Description

Location:

Start New Search:

nyc health hospitals
grand rounds
immediately hiring
home care agency
lab work
private duty
hemodialysis
lpns
licensed practical nurse lpn
utilization management
nys
queens
care manager
bronx
lvn
care management
med surg
nyc
managed care
manhattan

Out Patient UM Nurse

Share Job
Suggest Revision
Metroplus Health PlanNew York, NY
  • Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care.
  • We believe that Health care is a right, not a privilege.
  • If you have compassion and a collaborative spirit, work with us.
  • You can come to work being proud of what you do every day.
  • About NYC Health + HospitalsMetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
  • As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.
  • For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • Position OverviewThe Care Manager under the direction of the Sr. Director of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient.
  • The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.
  • Performs care management including hospital admission certification, continued stay review, discharge planning, out-patient and ancillary services review, etc., following established MetroPlus Utilization Management policies, procedures and protocols.
  • Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
  • Interacts and obtains relevant clinical information from member‘s PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlus Physician Advisor/Medical Director.
  • Informs member and provider of Utilization Management determinations and treatment alternatives.
  • Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
  • Evaluate member needs for referred cases (from providers or member self-referred).
  • Assists all departments with the resolution of members’ problems related to utilization management issues.
  • Performs all Utilization Management activities in compliance with all regulatory agency requirements.
  • Conducts medical record reviews as appropriate to case management functions.
  • Participate in Medical Management grand rounds with the Physician Advisor.
  • Performs all other duties as assignMinimum Qualifications
  • Bachelor’s Degree (BSN).
  • Licensed Practical Nurse (LPN) with hands on UM experience
  • Other Professional Licensure covering assignment scope (i.e., Physical Therapist)
  • A minimum of three to five years clinical experience in an acute care setting.
  • Excellent communication, written and analytical skills.
  • Knowledge of computer systems.
  • UM/UR experience in managed care or hospital setting required.
  • Registered Nurse, Current New York State license
  • License Practical Nurse, Current New York State license
  • Physical Therapist, New York State license

Similar jobs:

Active
  • All Jobs
  • Active
Care Manager (UM)
MetroPlusHealthNew York, NY
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.
Full-time
Nurse Care
MetroPlusNew York, NY
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus network includes over 27,000 primary care providers, specialists and participating clinics.
Licensed Practical Nurse (LPN)
Summit Home CareNew York, NY
Summit Home Care is a RN-owned and operated, JCAHO Accredited, NYS licensed home care agency that services all 5 Boroughs on NYC and Long Island.
$27 an hour Part-time
Licensed Practical Nurse (LPN) Needed - Flexible Hours
BAYADA Home Health CareNew York, NY
We have immediate needs for Licensed Practical Nurses (LPNs) in the following areas: Manhattan Staten Island Queens The Bronx Licensed Practical Nurses (LPNs) at BAYADA enjoy: Competitive wages Weekly pay Short commute times - we match you to cases near your home A positive and stable work environment and the tools you need to do your job.
Full-time/part-time
Licensed Practical Nurse LPN - Queens
Competent NursingCorona, NY
Responsibilities of the LPN - Licensed Practical Nurse
jobsearcher.com/blog
How to Craft a Resume for Teenagers + Examples

With the explosive growth of competitive after-school programs, scholarships, internships, and other opportunities, it’s never too early for teens to make a resume. Writing and designing a resume is a great way for teens to practice their employability skills while setting them up for success. Luckily, there are many resume examples for teens to follow to make creating a stand-out resume easy and stress-free.

Pre - Authorization Nurse
Metropolitan Jewish Health SystemBrooklyn, NY
Associated topics: lead, licensed practical nurse, licensed vocational, licensed vocational nurse, lvn lpn, med surg, mtp, nurse iv, pediatrics, practical
Licensed Practical Nurse (LPN - Night Tour
PAGNYNew York, NY
Physician Affiliate Group of New York (PAGNY) is comprised of nearly 3,000 physicians and healthcare professionals who provide services to NYC Health + Hospitals (H+H), the largest public health system in the United States.
Licensed Practical Nurse
Five Star NursingNew York, NY
Five Star Nursing - Currently seeking LPN / Licensed Practical Nurse for job openings.
$27 an hour Full-time
Licensed Practical Nurse (LPN) in QUEENS / SI / LI
Priority Care StaffingNew York, NY
We put our clients first with our steadfast commitment towards superior recruitment of medical and non-medical professionals for healthcare facilities.
Full-time
jobsearcher.com/blog
How to Build a Construction Superintendent Resume in 3 Easy Steps

If you’re reading this post, it’s likely you’re thinking about trying to score a construction superintendent role. You’ve probably already put several years of hard work into the construction industry and are ready to climb the ladder. This is great, but you’re also going to need a strong and impactful construction superintendent resume to get where you want to go. Let’s talk about how to create one that will impress employers.

Licensed Practical Nurse
YAI / NIPD NetworkJamaica, NY
Associated topics: lead, license, licensed practical, licensed practical nurse, lpn, med surg, mtp, nurse i, nurse iii, practical nurse lpn
Utilization - Nurse Care Manager
RCM Health Care ServicesNew York, NY
Participate in Medical Management grand rounds with the Physician Advisor.
$105,000 - $153,000 a year Full-time
Staff Nurse - Chronic ICU (WOUND CARE)
NYC Health+ HospitalsNew York, NY
Nurse Residency Program: Get the support you need to grow and thrive at NYC Health + Hospitals through our innovative program.
Full-time
Psychiatric Nurse Practitioner
Health ECareersJamaica, NY
The Icahn School of Medicine at Mount Sinai affiliated with Queens Hospital Center, serving the culturally diverse community of Western Queens, is seeking a full time Psychiatric Nurse Practitioner to join its Adult Outpatient Division.
Full-time
jobsearcher.com/blog
Performance Management: How to Track and Boost Employee Performance

Employee performance management is an integral part of building a strong and engaged workforce and driving long-term business growth. Performing well and being recognized not only increases employees’ personal motivation and job satisfaction, but it can also help build cohesive teams that continuously deliver or exceed on their KPIs (key performance indicators). 

Licensed Practical Nurse LPN - Day Tour
Physician Affiliate Group of NyKew Gardens, NY
Associated topics: hemodialysis, licensed practical, licensed practical nurse, licensed vocational nurse, lvn lpn, med surg, mtp, nurse i, pediatrics, practical
Offsite Licensed Practice Nurse - Nassau, Long Island
Mount Sinai Health SystemNew York, NY
Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai Morningside (Formerly St Luke's), and New York Eye and Ear Infirmary of Mount Sinai.

Latest Blog Posts:

jobsearcher.com/blogHow to Craft Your Resume SummaryWhen companies publish a help wanted ad, they are likely to get tons of responses. People may submit resumes even if they think they have an inkling of a chance to land the position. This leaves recruiters with the task of sorting through possibly hundreds of resumes to find the best applicants, and most of them will lighten their load by starting with the resume summary. 
jobsearcher.com/blogHow to Write a CVA CV, also known as a curriculum vitae, is key in helping job seekers connect with hiring managers, recruiters, and key decision-makers. Whether you’ve been actively job searching for a while or you’re just getting into the applicant pool, here’s what modern job searchers and students need to know when deciding how to write a cv. 
jobsearcher.com/blog3 Elements to Consider When Asked "Why Do You Want to Work Here?"If you are currently preparing for an interview, chances are you have come across the “why do you want to work here?” question, right? Although the reasons you have for wanting to work for a company may seem obvious to you, there is in fact a correct way to go about answering this question. 
jobsearcher.com/blogHow Long Should A Resume Be?Only about 2% of submitted resumes result in an interview, and with the increase of remote work, job applicants can come from anywhere. For job searchers, this means that your resume needs to stand out and capture a hiring manager or recruiter’s attention. 
jobsearcher.com/blog12 Do's and Don'ts of How to End an EmailOne of the issues we’re all encountering at the moment is what’s been described as ‘hyper novelty’. Not only has our society changed spectacularly, but the rate of that change is equally spectacular. The life of a blue-collar worker probably didn’t change that much for a long time. For example, for countless years quern stones were used for grinding. All that changed over that time was whether it was being powered by human strength, animals or water wheels.
jobsearcher.com/blogHow to Survive the First 90 Days of a Career ChangeThe hard work is done. You’ve tended your resignation without burning bridges. You’re at peace with the sunken cost of putting a successful career trajectory on hold. You’ve modeled out your cash flows. Your health insurance is buttoned up. After all, quitting should be easier for executives – with savings come safety nets. Yet, once they quit they look more like deer in headlights than wolves of Wall Street. I should know, six years ago I was one of them.
jobsearcher.com/blogHow to Choose a Career in 5 Easy StepsDeciding how to choose a career can end in you making a big decision, so it is one that doesn’t need to be rushed into. Deciding which path to go down for your career is exciting, but can also feel like a huge responsibility. When it comes to choosing a career, we are often made felt we should have it all figured out. I bet you can recall being as young as 16 in high school and being asked what line of work you wanted to go into. The truth is, most adults don’t even have it figured out, never mind high school kids!