- Highmark Health (Albany, NY)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- CenterWell (Albany, NY)
- …+ Monitor plan performance and proactively bring issues to the forefront for review + Support new business implementations with a goal of ensuring all pharmacy ... and present to client + Escalate issues for immediate review and action whenever necessary + Request, review...internal partners and the Medicaid market to manage pharmacy utilization and spend + Manage escalated member, client and… more
- The Institute for Family Health (Bronx, NY)
- … and workflows. Provides training and education as appropriate on diabetes specific clinical , procedural and technical aspects of care . + Job specific ... Travel Percentage Negligible Job Shift Day Job Category Health Care Description SUMMARY: The Certified Diabetes Care ...Adjust intensity of service based on needs, and appropriate utilization of resources. + Develop patient centered plan of… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... knowledge and demonstrates advanced beginner skills when providing and directing care for patients with end-stage renal disease (ESRD), acute kidney injury… more
- Albany Medical Center (Albany, NY)
- …facilitating the resolution of conflict. + Participate in case presentation in Complex Care Review to seek interdisciplinary input regarding challenging cases. + ... - required + 1-3 years as a social worker with experience in the field of Clinical Social Work with experience in care transitions - required + Ability to create… more
- Comunilife (New York, NY)
- …perform evaluations and maintain Comunilife policies and procedures, quality assurance, utilization review and outreach activities. The Program Coordinator will ... location. The Program Coordinator for Life is Precious (TM) is a non- clinical suicide prevention afterschool alternative program for Latina teens ages 12-17.… more
- New York State Civil Service (Orangeburg, NY)
- …Microsoft Excel is preferred. URCs at RCPC review electronic and paper clinical medical records for inpatient and outpatient care . Duties include:* Reviewing ... is looking to hire a Registered Nurse 1, Psychiatric, to serve as a Utilization Review Coordinator (URC). Candidates from outside or within State Service can… more
- City of New York (New York, NY)
- …partners. ACE staff ensures that all newly HIV-diagnosed persons are linked to HIV clinical care . ACE staff undertake the continuous education of providers and ... infections. BHHS accomplishes its mission through testing initiatives; prevention, care , and treatment programming; epidemiology and surveillance; training and… more
- Wellpath (Valhalla, NY)
- …month over month and a very large percent of those individuals receive direct clinical care , which includes lives saved by Narcan. We offer ongoing training ... through adherence to policies and procedures for admission and transfer, utilization review , and referrals. + Assumes responsibility and accountability for… more
- City of New York (New York, NY)
- …practices. - Provide technical assistance to contracted providers to ensure effective utilization of clinical assessment tools. Program Strategy & Service ... 100 programs and supports a family-driven, individualized and strength-based approach to care . The portfolio includes the NYC Perinatal and Early Childhood Mental… more