- Centene Corporation (New York, NY)
- …flexibility. **Must be licensed in the state of New York.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient...preferred. Experience working with providers and healthcare teams to review care services related to mental health… more
- CDPHP (Albany, NY)
- …experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This ... completing inpatient level of care reviews, post-acute care initial and concurrent reviews for acute...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria.… more
- Mohawk Valley Health System (Utica, NY)
- …Support Recovery Audit Contractors (RAC's). + Assist with mitigating barriers to discharge and care progression. + Perform concurrent review of cases greater ... 2nd Midnight across payor types (CMS regulation). + Perform concurrent review and escalation of cases not... clinical documentation specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review… more
- Guthrie (Binghamton, NY)
- …and educational activities. a) Incorporates available current evidence based data for clinical care management. b) Demonstrates knowledge of federal, state and ... in an acute care setting with strong care management, utilization review , and payer knowledge....with the patient and family/caregivers, physician and other health care providers to achieve designated clinical , operational… more
- Mount Sinai Health System (New York, NY)
- … information requested by the managed care companies as part of the concurrent review in a timely fashion. c. Provides clinical information requested ... care and coordination of services based on clinical needs and available resources. + Utilization Review...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information… more
- Mount Sinai Health System (New York, NY)
- … information requested by the managed care companies as part of the concurrent review in a timely fashion. 3. Provides clinical information requested ... care and coordination of services based on clinical needs and available resources. 3. Utilization Review...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information… more
- Trinity Health (Troy, NY)
- …Utilization Management and works collaboratively with Utilization Management/ Concurrent Review Nurse, physicians, staff and other health care professionals. ... concurrent denials, forwards information to the appropriate Utilization Management/ Concurrent Review Nurse within identified process standards * Reviews… more
- Catholic Health Services (West Islip, NY)
- …Administrative Staff. Ensures compliance with Hospital Conditions of Participation. Implements care management programs, including utilization review , intake and ... Evaluates patient care data to ensure that care is provided in accordance with clinical ...federal, state and QIO regulations. Familiarity with admission and concurrent in-patient criteria is preferred. Experience with data analytics… more
- Ankura (Lexington, NY)
- …healthcare litigation support, Ankura's Healthcare Disputes team combines unparalleled clinical , technical, and operational experience with the financial, economic, ... may be facing. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic… more
- Cardinal Health (Albany, NY)
- …to rethink the reach and impact of their products. **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for ... (TM) Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy… more