- Highmark Health (Albany, NY)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- City of New York (New York, NY)
- …Participate in all quality monitoring activities related to SCU medical supervision. - Review medical consent override requests from foster care agencies and ... foster care agencies and medical facilities. - Participate in review and collect medical documentation for non-Medicaid reimbursable requests. - Examine various… more
- STG International (Watertown, NY)
- …and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... patients of the Veterans Affairs Medical Center (VAMC). This care will be delivered in accordance with the terms...Medical Director will also collaborate with the CBOC Clinic Manager to supervise the CBOC's day-to-day delivery of medical… more
- Villa of Hope (Rochester, NY)
- …Ensures full participation of Tuckahoe staff in compliance, quality assurance, utilization review , and program evaluation activities. Maintains operating ... operational leadership to the Tuckahoe Community Residence program (supervising the program manager and therapist), as well as clinical leadership to mental health… more
- Mount Sinai Health System (New York, NY)
- …practice which includes review of policies and procedures and standards of care ; the practice of nurses according to full scope within the legal regulations of ... through the organization and oversight of all policies and procedures and standards of care , insuring all are within the scope of nursing practice and in accordance… 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
- Elevance Health (New York, NY)
- …necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer ... advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate… 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
- University of Rochester (Rochester, NY)
- …Clinical Materials Services Unit (CMSU). **ESSENTIAL FUNCTIONS** Quality Assurance Review and Verification of Production Operations + Oversees production receiving ... and packaging components to pre-approved specifications. + Incoming inspection and review of all labeling, drug products and components documentation for conformance… more