- Evolent (Albany, NY)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Albany, NY)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Albany, NY)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals .… more
- Mount Sinai Health System (Long Island City, NY)
- …The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case ... able to navigate through a wide variety of managed care contractual issues. Must have knowledge of and familiarity...5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience in Case Management… more
- MTA (Brooklyn, NY)
- …of New York. + Minimum of two (2) - three ( 3 ) years of clinical medical practice, satisfactory patient care , or residency program experience. Specialty Board ... needed basis , 1 to 3 days per week serving on the Paratransit Eligibility Appeals Board. The physician will provide medical expertise and support in the review … more
- Guthrie (Corning, NY)
- …are no delays in patient care while they are not in the office LPN Clinical Care * *Dressing changes, injections, rooming and patient care as directed ... and complete appeals for denials as needed * *Monitor and Review REMS clearance for monthly refills of high-risk medications ordered for patients Monitor… more
- Mount Sinai Health System (New York, NY)
- …to discuss plan of care and coordination of services based on clinical needs and available resources. + Utilization Review : a. Maintains a working ... the clinical information requested by the managed care companies as part of the concurrent review...and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
- Centene Corporation (New York, NY)
- …Assist in the development and implementation of physician education with respect to clinical issues and policies. + Identify utilization review studies and ... implementation of recommendations to providers that would improve utilization and health care quality. + Review claims involving complex, controversial, or… more
- Mount Sinai Health System (New York, NY)
- …to discuss plan of care and coordination of services based on clinical needs and available resources. 3. Utilization Review : 1. Maintains a working ... the clinical information requested by the managed care companies as part of the concurrent review...and managed care companies on concurrent denial appeals 5. Communicates clinical information to the… more
- Catholic Health Services (West Islip, NY)
- …but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ... Staff. Ensures compliance with Hospital Conditions of Participation. Implements care management programs, including utilization review , intake...Evaluates patient care data to ensure that care is provided in accordance with clinical … more