- Fresenius Medical Center (New York, NY)
- …determining project specifications and review methodologies. Analyses will include review of claims data, analysis of medication utilization for global ... the consolidation, analysis and reporting of commercial revenue. Develops standards of review and analysis to facilitate accurate and timely analysis of all… more
- Molina Healthcare (Rochester, NY)
- …abuse, and over utilization by providers and recipients. The position will review claims data, medical records, and billing data from all types of healthcare ... **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager , SIU, the Team Lead is responsible to lead a small team of investigators and provide… more
- Mount Sinai Health System (New York, NY)
- …the Mount Sinai Health System. Our mission is to provide unparalleled patient care , to conduct cutting-edge research and to train tomorrow's physicians. Our faculty ... preferred. + 5-7 years minimum of experience in health care , particularly an academic medical center, strongly preferred. +...have a proven track record of success as a manager , with superb interpersonal skills, including both written and… more
- Villa of Hope (Rochester, NY)
- …coordinator, providers, director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and when needed ... TITLE: Intake Coordinator- RN/ Evening DEPARTMENT/PROGRAM: Medical Services SUPERVISOR: Nurse Manager /Health Coordinator PAY GRADE: 82 FLSA STATUS: NON EXEMPT JOB… more
- Glengariff Rehabilitation and Healthcare Center (Glen Cove, NY)
- …trends on a monthly basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates in, and attends ... and company policy and procedures. Acts as in-house case manager by considering all aspects of the residents ...manager by considering all aspects of the residents care and coordinating services with physicians, families, third party… more
- Trinity Health (Syracuse, NY)
- …presence within our communities. Vision: .To be world-renowned for passionate patient care and outstanding clinical outcomes. Core Values: .In the spirit of good ... + Front desk staff report to this position who then reports to Practice Manager . + Management of staff schedules + Lead and participate in projects that improve… more
- CenterWell (Albany, NY)
- …by accessing and understanding formulary restrictions, plan limitations, drug utilization review overrides, requesting and completing prior authorization, ... good practices within the value-based model. + Know and continually review medication brand and generic names, medical terminology, and pharmaceutical calculations.… more
- Access: Supports For Living (Howard Beach, NY)
- …other entities as required (OPWDD 147 form, etc.) + Support appropriate budget utilization : Review expenditures for overage issues and address such issues with ... Essential Functions: + Oversee a caseload of 60-80 participants + Review , upload and approve budget, budget amendments/CNBAs/Annual Rollovers within eVero portal.… more
- WellLife Network (South Richmond Hill, NY)
- …location and schedules are subject to change. + Attend certification inspections, utilization review and independent professional reviews as needed. + Attend ... along with Client Coordinator. + Act as a medical resource person for Residence Manager and staff to ensure proper medical care and follow through on… more
- Elevance Health (New York, NY)
- …policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions listed ... is a benefit-management leader in Illinois. Our platform delivers significant cost-of- care savings across an expanding set of clinical domains, including radiology,… more