- Helio Health Inc. (Syracuse, NY)
- …+ Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care , or managed care setting. ... referring to the medical provider those that require additional expertise. + Review clinical information for concurrent reviews, extending the length of… more
- Humana (Albany, NY)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : ... part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical… more
- Guidehouse (New York, NY)
- …on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
- WMCHealth (Valhalla, NY)
- …Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management Department: Clinical Care Management Union: Yes Union Name: NYSNA ... investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at...report on hospital incidents; develop procedures to improve patient care ; assist in carrying out all aspects of the… more
- University of Rochester (Rochester, NY)
- …work is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent acute hospital ... Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: Range: UR URCB 213 Compensation...insurance companies. The UM RN is responsible for the review of clinical documentation utilizing evidence based… more
- CenterWell (Albany, NY)
- … clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …staff as needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you ... will: In concert with the agency's mission and goal of sustaining high quality care /service delivery to persons served, the Utilization Manager works to assist… 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 ... LPCC or LMFT (for Behavioral Health Care Review Clinicians only). **Preferred Experience** 3-5 years clinical...Experience** 3-5 years clinical practice with managed care , hospital nursing or utilization management experience.… more