- CenterWell (Clifton Park, NY)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...of care analysis to determine efficiency, the efficacy of case management system as well as any… more
- Molina Healthcare (New York, NY)
- …**Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs ... management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case ...all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the… more
- City of New York (New York, NY)
- …or requirements. - Oversee and ensure cohesive juvenile detention center management , including programming, case management , recreation, skills-building, ... of Youth & Family Justice (DYFJ) is responsible for oversight and management of secure and non-secure detention services for juveniles awaiting disposition in… more
- Evolent (Albany, NY)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Ellis Medicine (Schenectady, NY)
- …plan, implement and evaluate individual healthcare needs. Integrate Discharge Planning, Utilization Review and Performance Improvement activities at the patient, ... levels. Efficiently and effectively anticipates, identifies and resolves issues through utilization review and discharge planning processes. Collaborates with… more
- Evolent (Albany, NY)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- Highmark Health (Albany, NY)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned ... to appropriate resources for additional support. + Implement care management review processes that are consistent with...**Required** + 7 years in any combination of clinical, case / utilization management and/or disease/condition … more
- Humana (Albany, NY)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Albany, NY)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Albany, NY)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more