- Northwell Health (Melville, NY)
- …plus specialized certifications as needed. Preferred Skills 3-5 years experience in Utilization Review , Case Management, and Clinical Appeals. 3-5 years of acute ... payer. Prepares and defends level of care and medical necessity for assigned case . Collaborates with physician advisor, payor representative and site case … more
- Humana (Albany, NY)
- …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 ... experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute… more
- HCR Home Care (Plattsburgh, NY)
- …software. Notify staff, as appropriate, to ensure proper coordination of care. + Review and approve all interim orders before they are sent to physician. Notify ... task appears on the action screen + Participate in case conferences, as needed, and process recert/discharge decisions based...MRS is unable to retrieve the unsigned order. + Review and follow-up on entitlement verification issues. + Verify/Ensure… more
- Achieve Beyond (Forest Hills, NY)
- …and other professionals. + Conduct collaborative activities with other professionals working on a case . + Educate all individuals involved in a case on different ... program timelines + Present updates on cases at Annual Review and/or program review meetings as needed....+ Utilize various systems to ensure documentation for a case is completed and meets regulatory expectations. + Administrative… more
- MetLife (New York, NY)
- …supervise PRT case level pricing from end-to-end: Perform, manage, and lead PRT case level pricing including review of plan documents; analyze participant & ... recommend assumptions; perform calculations and sensitivity analysis; analyze profitability; review investment portfolios; review offer letters and contracts;… more
- City of New York (New York, NY)
- …issues made by tenants, landlord, lawyer, advocate, legal aid via a review conference to achieve resolutions; addresses request for information and services from ... timely and ensures the annual renewal of RAP subsidies. Review the approvals of modifications made by the tenants...work performed as well as monthly audits. Assist with case consultation on individual cases and guidance on difficult… more
- City of New York (New York, NY)
- …Follow-up with case manager and appropriate staff on these issues Review drug resistant/drug intolerant TB patients, including MDR and rifampin resistant monthly ... loan forgiveness programs and state repayment assistance programs. Please review the notice to see if you may be...weekly with PHAs and other clinic staff to conduct case management "rounds" on all Class III patients in… more
- City of New York (New York, NY)
- …children in ACS's care is comprehensive and appropriate. OCFH also offers individualized case consultations and training to ACS staff and foster care agencies on a ... developing medical and mental health policies that support best case practice agency wide. The Office of Child and...ongoing one to one supervision with unit staff. - Review and evaluate medical services for children with special… more
- City of New York (New York, NY)
- …timely manner. Provide the second level of approval on all grants submitted after a review of the packet has been completed, which require reviewing the case ... to see the actions taken by the BOS/ABOSI staff, review SI Grant Screen in POS, review ...issuance codes associated with the issuances. Determine whether all case actions are correct and forward case … more
- City of New York (New York, NY)
- …hearings for DSS cases, processing summons services, subpoena requests, preparing case post court hearing decisions and other difficult and multiple clerical ... that the daily workload is processed effectively and within permitted timeframes. Review work to assess staffs' performance and identify deficient areas. Ensure that… more