- City of New York (New York, NY)
- …is recruiting for (1) one Principal Administrative Associate, who will function as a Senior Case Reviewer : - Conduct legally mandated case reviews to comply ... with all statutory, regulatory, and contractual standards. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert Packer ... collaborative relationships with members of the healthcare team. + Proactively researches case findings related to payer audits of UM decisions and prepares input… more
- Healthfirst (NY)
- **Duties//Responsibilities:** + The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical records and ... and make informed clinical judgments and recommendations. + The Medical Peer Reviewer will render determinations in the format and within timeframes to follow… 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 ... explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts with Health… more
- City of New York (New York, NY)
- …Program Evaluator is responsible for the following: - Evaluate contracted provider agency case practice utilizing the standardized PAMS review tool - Compile, ... Agency Measurement System Unit (PAMS) is responsible for conducting comprehensive, annual case record evaluations of all foster care, preventive and Close to Home… 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 ... explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts with Health… more
- City of New York (New York, NY)
- …Support Services (OCSS) is recruiting four (4) Clerical Associate III's, functioning as Case Review Specialists, Under supervision of the Unit Supervisor of Data ... latitude for independent judgment, the Clerical Associate III, functioning as Case Review Specialist, is responsible for reviewing reports to correct and… more
- City of New York (New York, NY)
- …for (1) one Principal Administrative Associate, who will function as a Medicaid Quality Control Case Review Supervisor who will: - Review the audit findings ... review of completed assignments to ensure consistency in case error finding methodology. - Train and update Quality...capture the elements necessary to assist the Quality Control Case Reviewers in their eligibility review findings.… more
- New York State Civil Service (New York, NY)
- …No Agency Attorney General, Office of the Title Support Services Liaison: Case Worker, Labor Bureau (6409) Occupational Category Legal Salary Grade NS Bargaining ... New York State Attorney General's (OAG) is seeking experienced case workers, or similarly qualified individuals, to serve as...needed, please include a cover page to provide the reviewer with any relevant context or background information. *… 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. Manager or ... limited to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more