- Mohawk Valley Health System (Utica, NY)
- …to our diverse member population. Provides direct oversight of the case manager 's daily operations of utilization review practice, processes and ... Management - SNH is responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties… more
- Ellis Medicine (Schenectady, NY)
- …by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social ... SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for ...inpatient experience in a hospital environment preferred. + Previous case management, utilization review , and… more
- Helio Health Inc. (Syracuse, NY)
- …track, review , and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ... issues. To support the mission of Helio Health, theUtilization Case Manager will enhance the program's efforts...Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address ... Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts… more
- Mount Sinai Health System (New York, NY)
- …Requirements + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... **Job Description** **RN/ Case Manager MSH Case ...a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case… more
- Guthrie (Binghamton, NY)
- …clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the ... On Bonus For Qualified RNs! Position Summary: The Acute Case Manager utilizes industry accepted processes for...care setting with strong care management, utilization review , and payer knowledge. A Case Management… more
- Bassett Healthcare (Oneonta, NY)
- …to achieve continuous improvement in both areas. + Refers cases and issues to Case Review , Utilization Committee, Medical Director, and Director of Quality ... best quality of life possible. What you'll do The Case Manager RN supports the physician and...accurate information to payors. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The… more
- Molina Healthcare (Yonkers, NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
- Stony Brook University (Stony Brook, NY)
- Case Manager - Part Time Temporary **Position Summary** At Stony Brook Medicine, a **TH Staff Associate/ Case Manager ** is a valuable member of our team, ... high standard of excellence. **Duties of a TH Staff Associate/ Case Manager in the Care Management Department...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation… more