Top 21 Utilization review Jobs in Utica, Ny

Nursing Assistant
COORDINATED CARE ALLIANCE NY INC —Utica, NY
- $20.00 - $22.66 an hour
- Experience working with individuals with developmental disabilities
- Medical office experience
- Public speaking
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7d
Vice President, Quality Improvement & Utilization Management
Nascentia Health —Rome, NY
- $157,427 - $203,581 a year
- Full-time
- Hybrid work
- Background check
- Pass drug screening
- Analysis skills
- Health savings account
- Paid holidays
Program Services Manager
The House of The Good Shepherd —Utica, NY
- $66,072 a year
- Full-time
- Management
- Mid-level
- Bachelor's degree
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10d
Remote RN Care Manager -NY Licensed Only
Xtreme Care —New York State
- $70,000 - $75,000 a year
- Full-time
- Remote
- Nursing
- Vital signs
- RN License
- Health insurance
- Dental insurance
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Behavioral Health Provider (Full-time / Part-time Opportunities Available)
Upstate Caring Partners —Utica, NY
- $60,000 - $80,000 a year
- Part-time
- Hybrid work
- LMFT
- Addiction Medicine
- Mid-level
- Health insurance
- Dental insurance
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Bilingual Remote RN Care Manager -New York State
Xtreme Care —New York State
- $70,000 - $75,000 a year
- Full-time
- Remote
- Nursing
- Vital signs
- RN License
- Health insurance
- Dental insurance
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PHYSICIAN ADVISOR
Mohawk Valley Health Systems —Utica, NY
- $200,000 - $300,000 a year
- 8 hour shift
- Medicine
- 1 year
- Senior level
Quality Assurance Specialist - Clinic
The Arc Madison Cortland —Oneida, NY
- From $17 an hour
- Mid-level
- Clinic
- Continuous improvement
- Paid holidays
- Health insurance
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2d
CASE MANAGEMENT RN
Oneida Health —Oneida, NY
- $36.00 - $45.72 an hour
- Full-time
- Nursing
- Anatomy knowledge
- RN License
RN Case Manager
Rome Health —Rome, NY
- $38.00 - $51.50 an hour
- 12 hour shift
- Nursing
- RN License
- Bachelor of Science
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RN - MDS Coordinator - RNC - Full Time - Days
Mohawk Valley Health Systems —Utica, NY
- $60,000 - $100,000 a year
- 8 hour shift
- Nursing
- RN License
- BLS Certification
Travel Case Management RN
Fastaff —United States
- Up to $2,826 a week
- Full-time
- Background check
- Nursing
- RN License
- Mileage reimbursement
- Health savings account
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10d

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Vice President, Quality Improvement & Utilization Management
Nascentia Health —Syracuse, NY
Bachelor's degree required in nursing, public health, administration, or a related field; Master's degree preferred or applicable extensive experience.
$157,427 - $203,581 a year
Vice President, Office of Community Renewal
New York Housing Trust Fund —Syracuse, NY
This role will provide high level direction, guidance and hands-on support for OCR’s state-funded program areas. Lead program activities as needed.
$141,581 - $150,000 a year
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Family Preservation Clinical Supervisor
Mentor Behavioral Health —Columbus, OH
Current driver's license, car registration, and auto insurance if providing transportation to individuals receiving services. 401(k) with company match.
$75,000 a year
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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Nursing Assistant

COORDINATED CARE ALLIANCE NY INC
Utica, NY

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Job Details

$20.00 - $22.66 an hour
7 days ago

Qualifications

High school diploma or GED

Full Job Description

Job Summary:

The Nursing Assistant is a non-licensed, nurse-adjacent clinical support position responsible for assisting the clinical team with proactive high-utilizer review, medical record retrieval, EHR record reconciliation, and communication with Care Management. The Nursing Assistant reviews IT generated high utilization reports and available health records (EHR) to determine whether key documents including hospital/ER discharge summaries, and annual physical examinations are present and current in the EHR. The position works with Care Managers, healthcare providers, hospitals, and health information management or medical records offices to obtain outstanding documentation and communicate relevant information to the Care Management and Clinical team.

The Nursing Assistant uses knowledge of medical terminology and healthcare documentation to locate and summarize information explicitly documented in records, including diagnoses, medications changes, follow-up instructions, referrals, testing, and recommended appointments. The Nursing Assistant does not independently assess a member, interpret clinical findings, diagnose conditions, make treatment recommendations, or determine whether a clinical consultation is required. Concerns, recurring patterns, and questions are elevated to the Director of Nursing or Behavioral Health.

Supervisory Responsibilities:

None

Essential Duties and Responsibilities:

Review IT-generated reports identifying members designated as high-utilizers.
Prioritize reviews using thresholds and work queues established by Clinical Leadership, including the designated discharge-summary completion threshold.
Review the EHR to determine whether a current annual physical examination is on file and whether discharge documentation is available for identified emergency department visits and inpatient admissions, as well as other relevant clinical documentation needed for RN review (e.g., lab results).
Identify whether records include clearly stated diagnoses, medication changes, test results requiring follow-up, referrals, appointments, discharge instructions, and other documented next steps.
Follow established procedures for uploading, indexing, labeling, and storing documents in the EHR or routing documents to authorized staff for entry.
Contact the assigned Care Manager to determine whether missing discharge documentation or an annual physical has already been requested and to obtain the current status.
Remind the Care Manager of outstanding documentation and member follow-up needs in accordance with established roles, timeframes, and escalation procedures.
Document outreach attempts and outcomes in the approved tracking system and, when required, in the EHR.
Elevate unresolved requests, repeated non-response, access barriers, or overdue follow-up through established Clinical and Care Management leadership channels.
Request discharge summaries, emergency department records, annual physical examinations, and other authorized medical documentation from hospitals, provider offices, and medical records departments for members identified as high utilizers.
Confirm that appropriate consent or authorization is present before requesting or disclosing protected health information and use only approved release forms and secure communication methods.
Track requests from initial submission through receipt, including dates, requested documents, contact information, responses, denials, fees, and additional authorization requirements.
Follow up on outstanding requests at established intervals and coordinate with Care Management when member or representative action is required.
Review received documents for member identity, date of service, document type, and apparent completeness before uploading or routing.
Prepare a concise, factual summary of newly received discharge documentation for the Care Manager and Nursing Team.
Identify and communicate diagnoses, medication changes, stated follow-up instructions, referrals, tests, recommended appointments, and other next steps exactly as documented in the source record.
Note recurring documented utilization reasons, repeated discharge instructions, or apparent follow-up gaps for review by Nursing without drawing clinical conclusions.
Refer records with concerning findings, recurring patterns, new diagnoses, significant medication changes, unclear instructions, or unmet follow-up needs to a Registered Nurse or the Director of Nursing.
Report misdirected, incomplete, illegible, or potentially incorrect records immediately and follow privacy, compliance, and incident-response procedures.
Follows all mandated reporting requirements.
Adheres to all company policies and procedures.
Performs other duties as assigned.
Maintains confidentiality.
Must possess a valid Driver’s License from New York, or a contiguous state (i.e., Connecticut, New Jersey, Pennsylvania, and Vermont) OR must have the ability to take ample public transportation to attend meetings in person in the community and in the office as needed.

Education and Experience:

High school diploma or equivalent required. Associate degree or postsecondary training in Medical Assisting, Health Information Technology, Medical Office Administration, Licensed Practical Nurse (LPN), or a related healthcare field preferred.
Completion of a recognized Medical Assistant, Medical Scribe, Health Information, LPN or medical terminology program preferred.
Minimum of two years of experience in a medical office, hospital, health information management, medical records, care management, care coordination, utilization review, or related healthcare setting preferred.
Experience requesting records from hospitals and provider offices and working with medical release requirements is strongly preferred.
Experience using an EHR and reviewing discharge summaries, annual physical, medication lists, and other healthcare documentation preferred.
Experience supporting people with intellectual and developmental disabilities and familiarity with OPWDD services preferred.
Absolute sense of integrity and personal commitment to serving people with IDD and their families.
Excellent interpersonal, public speaking, and written communication skills.
Ability to work autonomously.
Demonstrate leadership abilities.
Demonstrate professionalism, respect, and ability to work in a team environment.

AAP/EEOC

CCANY provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, the organization complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, training, and all other legally protected classifications.

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Refine Your Search

utilization review jobs in utica, ny

Nursing Assistant

Vice President, Quality Improvement & Utilization Management

Program Services Manager

Remote RN Care Manager -NY Licensed Only

Behavioral Health Provider (Full-time / Part-time Opportunities Available)

Bilingual Remote RN Care Manager -New York State

PHYSICIAN ADVISOR

Quality Assurance Specialist - Clinic

CASE MANAGEMENT RN

RN Case Manager

RN - MDS Coordinator - RNC - Full Time - Days

Travel Case Management RN

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