Utilization management rn jobs in New Rochelle, New YorkCreate job alerts

Job Title: RN Care Manager Location: White Plains, NY Per Diem | Day Shift (9 AM–5 PM) Weekend Requirement: Minimum 2 shifts/month Pay Rate: $60–$76/hr. Job Summary We are seeking an experienced RN Care Manager to complete comprehensive patient assessments, coordinate multidisciplinary care, and manage all aspects of discharge planning. This role focuses on supporting high-risk patients, collaborating with healthcare teams, and performing Utilization Review activities to ensure quality outcomes and reduce readmissions. Responsibilities • Perform comprehensive initial assessments and ongoing patient reassessments., • Coordinate care plans across all levels of care., • Manage all transitional planning, including aftercare arrangements and commercial payer communication., • Provide education to patients and caregivers., • Identify needs of high-utilizer patients and address root causes., • Collaborate with healthcare teams and maintain clear communication., • Support departmental goals: LOS reduction, readmission prevention, and denial reduction., • Complete all required documentation accurately., • Conduct Utilization Review activities such as clinical reviews, disposition determinations, and retro audits., • Assess and coordinate safe discharges for geriatric and diverse patient populations., • Participate in quality and performance improvement initiatives. Requirements • BSN required, • Active NYS RN License required, • PRI Certification (or willingness to obtain within 3 months), • Screen Certification preferred, • Care Management certifications (CMC, CCM) preferred, • 3+ years of ED, critical care, or med-surg experience preferred, • Prior case management experience preferred, • Familiarity with Milliman/InterQual criteria strongly preferred, • Strong computer and documentation skills Apply Now If you are a dedicated RN seeking a flexible per-diem role with strong support and competitive pay, we’d love to speak with you! 👉 Submit your resume today to be considered immediately.

Key Responsibilities Implement, coordinate, monitor, and evaluate medical review cases using clinical experience Apply clinical criteria and guidelines to make medical determinations for clients Assist in training new nurse reviewers and recommend process improvements to enhance quality and clie

Role Overview We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. ### Key Responsibilities - Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. - Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools. - Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. - Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements. - Product Development Collaboration: Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation. - Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. ### Required Qualifications - Licensure: Registered Nurse (RN) or equivalent clinical background. - Experience: Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management. - Certifications: CPC, CCS, or CRC certification preferred. - Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures. - Analytical Skills: Strong understanding of clinical documentation standards and payer logic. - Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. ### Preferred Qualifications - Experience working within hospital revenue integrity teams or insurance utilization management. - Exposure to AI-powered healthcare documentation tools or automated coding systems. - Ability to identify and flag edge cases or policy exceptions in automated workflows. - Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. ### Engagement Model - Contract / Part-time (Remote/In person) — Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus