- Excellus BlueCross BlueShield (Buffalo, NY)
- …care management rounds. + Provision of clinical oversight and leadership to Utilization Management / Case Management (UM/CM) staff working with the ... calls in timely manner and provides support for the Case Management (CM) and Registered Nurse (RN)...Develops and implements the BH sections of the Quality Management / Utilization Management (QM/UM) Plan, including… more
- Molina Healthcare (Yonkers, NY)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...appropriately all case related information in the case management system in an accurate manner,… more
- University of Rochester (Rochester, NY)
- …patients, families, third-party payers, governmental agencies, employers, social work, financial case management , clinical team and contracting. The Health ... of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain… 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
- Catholic Health (Kenmore, NY)
- …care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or Disease ... member of the Care Management and interdisciplinary care team, provides comprehensive case management and discharge services to patients and families in the… 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
- Elevance Health (New York, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... a State agency.*_ **Preferred Skills, Capabilities and Experiences:** + 1-2 years Utilization Management experience strongly preferred. + Strong oral, written,… 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
- 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...timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more