- Humana (Albany, NY)
- …help us put health first** The Bilingual Telephonic UM Coordinator / UM Administration Coordinator 2 provides non- clinical support for the policies and ... procedures ensuring best and most appropriate treatment, care or services for members. Bilingual Telephonic UM Coordinator + Primarily receive calls from… more
- Independent Health (Buffalo, NY)
- …clinical information, data entry of requests, preparation of the documents for clinical review and/or administrative review per standard operating ... Management, departments. The UMA is the first line of review in the UM prior authorization process,...NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in… more
- Healthfirst (NY)
- …Monitors assigned case load to meet performance metric requirements + Functions as a clinical resource for the multi-disciplinary care team in order to maximize ... State + Department of Health (NYSDOH) regulations governing medical management in managed care + Relevant clinical work experience + Intermediate Outlook, Basic… more
- CDPHP (Albany, NY)
- …to take prior to logging and routing requests for authorization to the appropriate clinical reviewer . CSS reviews clinical documentation and determines at ... you to be a part of that experience. The clinical support specialist (CSS) provides administrative support to ...is being requested to allow efficient workflow. CSS reviews UM notification letters to ensure quality wording is chosen… more
- Molina Healthcare (NY)
- …other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... (RN) license in good standing. **Preferred Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Syracuse, NY)
- …other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... or a compact licensure. The ideal candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates… more
- Molina Healthcare (Albany, NY)
- …field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or ... programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies...LPCC or LMFT (for Behavioral Health Care Review Clinicians only). **Preferred Experience** 3-5 years clinical… more
- Molina Healthcare (Yonkers, NY)
- …other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional ... with some weekends and holidays.** Preferred Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Syracuse, NY)
- …of Nursing. Bachelor's Degree in Nursing preferred. **Preferred Experience** 3-5 years clinical practice with managed care , hospital nursing, utilization and/or ... assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term...illness and the site of service. The Lead, HCS ( Clinical ) functions as clinical staff lead in… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …+ Ensures strong collaboration and coordination between BH and PH care across the UM / CM staff. + Participates in clinical peer review recruitment and ... Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex care management rounds. + Provision of clinical oversight and leadership… more