- Centene Corporation (New York, NY)
- …concurrent review findings + Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members + ... being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member...to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical … more
- CenterLight Health System (Ridgewood, NY)
- …in care /case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably within ... comprehensive assessment, medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager - Care Delivery will follow all… more
- FlexStaff (New York, NY)
- …in care /case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably within ... **Req Number** 156311 FlexStaff is seeking a qualified Clinical Manager - Integrated Care Perm...medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager - Care Delivery will… more
- CDPHP (Albany, NY)
- …to take prior to logging and routing requests for authorization to the appropriate clinical reviewer . CSS reviews clinical documentation and determines at ... you to be a part of that experience. The clinical support specialist (CSS) provides administrative support to ...experience in a health insurance related discipline required. + Utilization management experience is preferred. + Knowledge of managed… more
- Evolent (Albany, NY)
- …you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical Director, ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- CenterWell (Hauppauge, NY)
- … of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... on-site at our Hauppauge, NY branch location.** The **RN Clinical Manager** coordinates and oversees all direct care...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Molina Healthcare (Buffalo, NY)
- …Experience** Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care , for… more
- Evolent (Albany, NY)
- …Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Albany, NY)
- … Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... Officer during Fair Hearings as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and… more
- Kaleida Health (Buffalo, NY)
- …conventions and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management ... successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan...5 years of experience in a large, complex acute care setting in a supervisory / administrative role required.… more