- Northwell Health (Bay Shore, NY)
- …follow up and action. + * Acts as a liaison with patient's insurance carrier ( case manager , utilization reviewer) to coordinate post hospital services and ... to the Hospital. Job Responsibility + * Performs concurrent review on all patients and share all problematic cases...as required. + * Participates in the maintenance of Utilization Management, Discharge Planning and Case Management… more
- Elevance Health (New York, NY)
- …to members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology ... regimens and supportive care. + Perform physician-level case review , following initial nurse review...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Highmark Health (Albany, NY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. ... industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans… more
- Molina Healthcare (Albany, NY)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical… more
- Rochester Regional Health (Rochester, NY)
- …necessity in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay ... 3 years acute hospital care experience not required. PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience preferred. + Bachelor's… more
- Elevance Health (Latham, NY)
- …appropriate area to refer or assign case ( utilization management, case management, QI, Med Review ). + Provides information regarding network providers or ... clinical information regarding case and determines...and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …federal regulatory mandates related to the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates and ... as needed, at the time of the annual performance review + Non-care manager support staff duties...daily and as needed basis for department related metrics: case and review timeliness, workflow volumes, referrals… more
- CenterWell (Albany, NY)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Elevance Health (Latham, NY)
- …of 4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of ... by law. The **Medical Management Nurse** is responsible for review of the most complex or challenging cases that...skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has… more
- Elevance Health (New York, NY)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
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