- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors ... Managers, physician advisors and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with all insurance… more
- Mount Sinai Health System (New York, NY)
- …Nurse denial phone calls for UM Nurse to follow + Prioritizes work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring it… more
- Molina Healthcare (Yonkers, NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Arnot Health (Elmira, NY)
- …errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to ... bring satisfactory resolution in coordination with other department staff 5. Relays denial information to appropriate billing clerks and management. 6. Follow up on… more
- Ellis Medicine (Schenectady, NY)
- …beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . * Utilization Management Activities; Collaborates with Case Managers and ... function is to provide administrative support to the Case Management Department . Responsibilities include maintaining case files, updating referral information, and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level III (in ... assigned to non-care managers are monitored by the care manager + The care manager provides feedback...under pressure. + Demonstrates proficiency in basic navigation and utilization of department specific applications: care management… more
- Catholic Health Services (West Islip, NY)
- …Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and ... is responsible for providing overall management of the Care Coordination department responsible for patient care coordination, including oversight of Managers of… more
- University of Rochester (Rochester, NY)
- …Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department : 500195 Medicine/AIR Ambulatory Work Shift: UR - Day (United States of ... GENERAL PURPOSE Under the direct supervision of the Practice Manager , Clinic Director and Nurse Manager works...effort of providers by reviewing reports such as Clinic Utilization , Master Templates and the volume of Referrals. +… more