- Northwell Health (Forest Hills, NY)
- …oversees and evaluates the appropriateness of care across the acute care continuum. Applies clinical expertise and medical appropriateness criteria to ... utilization , consultation and treatment plan.Participates in interdisciplinary patient care rounds.Discusses estimated length of stay, treatment and discharge… more
- MVP Health Care (Rochester, NY)
- At MVP Health Care , we're on a mission to create a...after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a ... + An opportunity to shape the future of health care by joining a team recognized as a **Best...or Health Home required. + Must demonstrate understanding of clinical and psychosocial issues that may alter treatment or… more
- Humana (Albany, NY)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical ...region or line of business. The Medical Director conducts Utilization Management of the care received by… more
- Mount Sinai Health System (New York, NY)
- …needs: + Records, reports, and interprets the clients responses to the plan of care . + Performs a patient record review with the collaborating physician in ... and other health team members. + Participates in peer review . + Incorporates research findings in clinical ...and interprets the clients responses to the plan of care . + Performs a patient record review … more
- CDPHP (Albany, NY)
- …clear understanding of prescription and medical benefits as it applies to the utilization review process. + Must demonstrate proficient experience with the ... experience. Under the direct supervision of a licensed pharmacist, the Managed Care Pharmacy Technician (Pharmacy Tech) is responsible for administering CDPHP member… more
- Whitney Young Health Center (Albany, NY)
- …guidelines, and knowledge of chronic health conditions to identify patient for care coordination services. + Collaborate with providers/ clinical team members to ... focusing care coordination attention on the at-risk population driving utilization and costs to improve efficiency, quality and patient satisfaction. + Engages… more
- Bassett Healthcare (Cooperstown, NY)
- …an assigned shift and is accountable for the delivery of safe patient care utilizing the nursing process. The ANM assesses, plans, delivers, coordinates, integrates, ... and evaluates nursing care related to patient needs at the expert level....nurse or group leader. Demonstrates consideration of safety, effective utilization of equipment and materials, and cost in managing… more
- Evolent (Albany, NY)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical… more
- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- …professionals. Supports colleagues through knowledge sharing to provide safe, quality nursing care Questions clinical practices for the purpose of providing ... Summary The Primary Care Mental Health Integration Registered Nurse is responsible for all elements of the nursing process when providing and/or supervising direct… more
- Elevance Health (Latham, NY)
- …ensures essential face-to-face onboarding and skill development. The **Behavioral Health Care Manager II** is responsible for managing psychiatric and substance ... and outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses appropriate screening… more