- Elevance Health (New York, NY)
- …office visits with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering ... manager . + May be responsible for an entire clinical program and/or independently performs clinical reviews....state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Kaleida Health (Williamsville, NY)
- …degree in Nursing required within five (5) years of hire to the position. Certified Case Manager (CCM) preferred. Employees in the job title prior to 3/29/10 are ... acute care Nursing Experience required. 2 years of experience in any combination of case management, home care and utilization review preferred. Knowledge of and… more
- Molina Healthcare (Yonkers, NY)
- …Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional ... for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and… more
- Elevance Health (New York, NY)
- …necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer ... ** Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery**...+ Extensive spine surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. + **Orthopedic… more
- Albany Medical Center (Albany, NY)
- …needed + Coordinates referrals to social services departments, WIC + Facilitates the utilization of resources to meet patient outcomes ( case management). + ... team when required. Under the supervision of the Nursing Supervisor and Nurse Manager , the Ambulatory Care RN provides nursing support to primary and subspecialty… more
- Catholic Health (Buffalo, NY)
- …for clinical performance and process improvement and provides operational and clinical support to the site Office Manager . The Care Coordinator oversees ... of (1) year experience as a registered nurse required + One year previous case , disease, or utilization management experience preferred + One year previous… more
- Elevance Health (Buffalo, NY)
- …Coordinator - RN Clinician** is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN ... clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan… more
- Medtronic (Queens, NY)
- …lives. The Surgical Onsite Specialist (SOS) is responsible for providing case support and customer support, training and education, and solution implementation ... Surgical Centers of Therapy (COTs). This role ensures seamless product utilization by assisting with on-site procedures, addressing customer inquiries, performing… more
- St. James Hospital (Hornell, NY)
- …information, assigns bed, and lets appropriate staff know. + Assists ED and Med/Surg manager with staff scheduling + Assists case management with completion of ... nursing staff within the facility along with elements of case management. Performs complex and varied tasks requiring independent...+ Serve as a resource to staff for solving clinical issues. + Act as a resource in identifying… more
- CVS Health (Albany, NY)
- …leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special ... in the care planning process in collaboration with the Care Manager , to include the following actions: assessment, goal setting, establishing interventions… more