- University of Rochester (Rochester, NY)
- …patients, families, third-party payers, governmental agencies, employers, social work, financial case management , clinical team and contracting. The Health ... written and verbal communication and customer service skills. Financial Management + Review each visit for insurance...payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third… more
- Highmark Health (Buffalo, NY)
- …creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review , status research, etc. Ensures ... IS ON-SITE** **ONLY This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses the… more
- Molina Healthcare (Syracuse, NY)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- City of New York (New York, NY)
- …- Determine training needs based on information obtained from internal audits and case review and share with unit supervisors for corrective actions. Ensure ... issues to the Assistant Program Manager to ensure effective utilization of resources. - Review and audit...and Resolution process by conducting internal audits and random review of case records from the various… more
- Outreach Development Corporation (Brentwood, NY)
- …the absence of the Program Director. M-F 9-5. Job Scope Leadership and Program Management : + Supports the Program Director to ensure ongoing and accurate input of ... electronic data. + Provides management and oversight of ambulatory services in the absence...appropriate sign off of UR, treatment plans, treatment plan review and discharge related paperwork to insure compliance +… more
- Glens Falls Hospital (Glens Falls, NY)
- …changes in patient condition that may necessitate treatment change and will attend regular case review meetings. The Care Manager will work closely with the ... Interdisciplinary Team to ensure appropriate utilization and provision of resources for patients including referrals...CCM or two years acute care/home * Care and/or case management experience preferred. * Masters Degree… more
- City of New York (New York, NY)
- …or at risk of homelessness. Projects may include client linkage to case management services, medical/mental health/substance use treatment, or linkage to ... shared services functions across agencies, which results in better day-to-day management and building an integrated mission across agencies. DHS's mission statement… more
- Garnet Health (Harris, NY)
- …Health Medical Center - Catskills Emergency Department. Additionally will provide case management , and discharge planning for non-psychiatric patients. The ... as necessary. Maintaining administrative records related to emergency evaluations and case management . Close collaboration with ED physician and other… more
- Rochester Institute of Technology (Rochester, NY)
- …respond to prospective student queries about the PASP application process. + Review PASP application materials including audition videos when needed, holding the ... the cloud-based platform. + Liaise with the Registrar's Office and Enrollment Management to ensure scholars have fulfilled their needed requirements. + Ensure PASP… more
- CVS Health (Albany, NY)
- …will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...driven timelines. Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more