- Molina Healthcare (Rochester, NY)
- …other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care ,… more
- CVS Health (Albany, NY)
- …Health Care Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM (Utilization Management) experience *Active and current state ... transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care...As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes… more
- WMCHealth (Valhalla, NY)
- …WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Physicians Department: Clinical Care Mgmt- WMC Health Union: No Position: Full Time ... clinical determinations cannot be made by initial clinical review . + Discusses determinations with requesting...and accurate manner. .Functions as a resource for initial clinical reviewers. + Serves on UM Committee… more
- Bassett Healthcare (Cooperstown, NY)
- …other provider) on medical necessity criteria to address all discrepancies Complete initial clinical review in electronic medical record (EMR) and follow the ... professionally and apply knowledge and skills necessary to provide care appropriate to each patient. Clinical and...review that meets criteria and schedule for next review Utilize knowledge of level of care … 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
- University of Rochester (Rochester, NY)
- …and various insurance companies. The UM RN is responsible for the review of clinical documentation utilizing evidence based criteria to support medical ... of the individual, and internal equity considerations._ **Responsibilities:** The Utilization Management ( UM ) RN position spans the entire health care system… more
- Elevance Health (Latham, NY)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... ensures essential face-to-face onboarding and skill development. The **Behavioral Health Care Manager II** is responsible for managing psychiatric and substance… more
- Stony Brook University (Stony Brook, NY)
- Care Manager - Readmission Specialist **_Position Summary_** _At Stony Brook Medicine the_ Care Manager - Readmission Specialist _must have both hospital and ... transitional care experience. The Care Manager - Readmission...readmission. The RN following these patients must have good clinical and communication skills to address the needs of… more
- Stony Brook University (Stony Brook, NY)
- Care Manager - Per Diem **Position Summary** At Stony Brook Medicine, a ** Care Manager** is a valuable member of our team, who provides clinical services to ... our patient population. Qualified candidates will demonstrate superior patient care and possess outstanding communication skills while adhering to our high standard… more
- Evolent (Albany, NY)
- … expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** ... Process improvement and enhancement of **provider engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited… more