- MVP Health Care (Rochester, NY)
- …management system + Responsible for identification and assignment of cases requiring concurrent review to the appropriate BH UM Clinician + Communicate with ... At MVP Health Care , we're on a mission to create a...team at ###@mvphealthcare.com . **Job Details** **Job Family** **Medical Management/ Clinical ** **Pay Type** **Salary** **Hiring Min Rate** **44,850 USD**… more
- Catholic Health Services (Melville, NY)
- …clinical expertise/reference for specialty services as needed to adequately prepare clinical review and/or appeal. Demonstrates aptitude and skill in applying ... to MCC in response to physician order, or review of updated clinical information Acts as...updates regarding third party contractual changes from the Managed Care Department and applies to UM and… more
- Molina Healthcare (Albany, NY)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA, FL, MI, MS, ... and action plan, which includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate care at the most… more
- Catholic Health Services (Melville, NY)
- …every patient, every time. Job Details Duties and Responsibilities: Inpatient Clinical Optimization: Care Coordination, Progression, and Variation 1. Regulatory ... Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation.… more
- Evolent (Albany, NY)
- …(FDA), and various prior authorization lists, facilitating timely decision-making for clinical and business review teams. + Demonstrate strong analytical ... in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care , or healthcare consulting environment. +… more
- Mount Sinai Health System (New York, NY)
- …Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical /Technical/Service** + Demonstrates the ability to perform clinical ... Insurance / State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts...departments + Monitors Concurrent Nurse denial phone calls for UM Nurse to follow + Prioritizes work as per… more
- Mount Sinai Health System (New York, NY)
- …Case Management FT Days** This position is responsible for coordinating requests for clinical information from third party payers and providing support to a broad ... & Denials Management.** Communicate with payer to obtain request for clinical information, payer authorization and determination _(ie frequent communication until… more
- Evolent (Albany, NY)
- …You Will Be Doing:** + Responsible for oversight of utilization management ( UM )/ care management (CM) correspondence development, internal and external approvals, ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...and on-going maintenance of corporate clinical correspondence to ensure compliance with legislative and accreditation… more
- Trinity Health (Troy, NY)
- …you are an experienced RN looking for a **_leadership_** position in the Observation/ Clinical Decision Unit to meet your schedule, this could be your opportunity. ... Here at St. Peter's Health Partner's, we care for more people in more places. **Position Highlights:**...M/S units. + Will work closely with Hospitalist and CM/ UM assigned to unit. **Functional Role (not inclusive of… more