- Northwell Health (Staten Island, NY)
- …and clinical pathways, variance analysis and trending, quality management/utilization review and home care /discharge planning, preferred. + Keeps abreast of ... team. + Serves as a resource to the health care team regarding quality, utilization of clinical ...care according to regulatory standards. + * Performs concurrent utilization management using Interqual criteria. + Conducts chart… 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. +...other child-serving systems, including the education system and foster care system. + Develops, conducts concurrent and… more
- Molina Healthcare (Albany, NY)
- …authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate ... local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states:...includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate … more
- WMCHealth (Valhalla, NY)
- …and works closely with the Trauma Registry to ensure accurate concurrent data collection and identification of performance improvement occurrences. The Performance ... Medical Director, Trauma Program Manager, Trauma Registrars and other disciplines to review the performance and safety of the Trauma Program including coordinating… more
- Molina Healthcare (Yonkers, NY)
- …expertise in the performance of prior authorization, inpatient concurrent review , discharge planning, case management and interdisciplinary care team ... + Develops medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** * Doctorate Degree in...+ 10+ years relevant experience, including 5+ years of clinical practice and 3+ years HMO/Managed Care … more
- New York State Civil Service (Staten Island, NY)
- …Treatment Center 1, M1 - South Beach ATC Occupational Category Health Care , Human/Social Services Salary Grade 661 Bargaining Unit M/C - Managerial/Confidential ... are not limited to:* Monitor and report quality of care issues with OASAS and the Justice Center including...regulations such as incident reports and investigations and incident review .* Achieve OASAS service level goals for overall occupancy,… more
- Helio Health Inc. (Syracuse, NY)
- …necessity, referring to the medical provider those that require additional expertise. + Review clinical information for concurrent reviews, extending the ... applicants preferred. + Two years of experience in utilization review in a hospital, health care , or managed care setting. + Knowledge of… more
- Catholic Health Services (Hauppauge, NY)
- …database to include appropriate current and past medical history, appropriate clinical and laboratory data, and concurrent medication (including over-the-counter ... in the state of NY. One-year experience in home infusion, hospital or managed care setting preferred. IV clinical experience preferred. Skill in use of… more
- University of Rochester (Rochester, NY)
- …GENERAL PURPOSE The NICU Data Manager will apply specialized clinical /medical knowledge regarding data definition, coding, and accreditation standards and ... registry elements. Prioritize, organize and meet tight deadlines for multiple concurrent tasks and team requests. Develop database structures and features customized… more
- UHS (Johnson City, NY)
- …Required: + Bachelor's in Nursing or related Healthcare field. Preferred: + 5 years of clinical experience in critical care , trauma, and/ or ER. + 2-3 years of ... The Trauma Performance Improvement Coordinator will conduct retrospective and concurrent case reviews of the critically injured patient from...patient from time of injury through the continuum of care to ensure that care is safe,… more