- CenterWell (Albany, NY)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases, Quality of Care cases, clinical ... evidence-based medicine skills are such that the individual provides review oversight for a broad array of clinical...Leads, develops, directs and implements clinical and non- clinical activities that impact health care quality… more
- Weill Cornell Medical College (New York, NY)
- …Sciences, and the Weill Cornell Physician Organization - are engaged in world-class clinical care and cutting-edge research that connect patients to the latest ... into the internal controls of the institution and that an appropriate financial review framework is in place to ensure that transactions on research grants are… more
- Catholic Health (Buffalo, NY)
- …organizations policies and procedures. To effectively maximize efficiency of operational and clinical components of patient care the System Director, will ... & Neurosciences is responsible for the overall operational, financial and clinical performance of the musculoskeletal and neuroscience practices, functioning in a… more
- CVS Health (New York, NY)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a ... to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical ...* 2 or more years of experience in Health Care Delivery System eg, Clinical Practice and… more
- Centene Corporation (New York, NY)
- …**Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring authorization. ... Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary...Psychology or Clinical Social Work. Three years clinical experience in a health care environment;… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex care management rounds. + Provision of clinical oversight and leadership ... across the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. +...Carve-In program members meets the standards for acceptable medical care + Fosters Clinical Practice Guideline implementation… more
- Bassett Healthcare (Cooperstown, NY)
- …and thorough review of referrals, patient advocacy for access to care , and appropriate scheduling and tracking of appointments for patients referred by BCI ... providers to non-Bassett specialists, clinics and treatment centers. The Patient Care Coordinator provides clinical information to case managers at insurance… more
- UHS (Binghamton, NY)
- …working with and under the direction of a registered nurse (eg clinical measurements, personal care , nutrition and hydration, specimen collection, shift ... is seeking a Mental Health Technician to support the care and safety of patients in our behavioral health...You'll work closely with nurses, social workers, and other clinical staff to support individualized treatment plans. The ideal… more
- SUNY Upstate Medical University (Syracuse, NY)
- …in Nursing, health or education related field and 3 years of direct patient care clinical experience required (preferably with diabetes care and management) ... in the areas of program development, implementation, marketing and review of clinical programs/services. Participates in the...degree in Nursing and 5 years of direct patient care clinical experience required (preferably with diabetes… more