- City of New York (New York, NY)
- …care agencies within the 5 boroughs 2. Participating in all post medical record review quality monitoring and corrective action processes 3. Conducting ad hoc ... health-related topics. The office also conducts research and provides clinical expertise in developing health and mental health policies...to maintain review tool validity and improve review quality as needed. - Identify and… more
- Stony Brook University (Stony Brook, NY)
- …clinically indicated and as permitted by practice agreement. + Participate in clinical research programs and quality improvement initiatives within the Division ... Practitioners and Physician Assistants** are valuable members of our team who provide clinical services to our patient population. We are seeking candidates to work… more
- Catholic Health (Buffalo, NY)
- …3-5 years Medical Surgical experience required. + 3-5 years Home Care clinical experience preferred (CHHA, licensed, long term home care) KNOWLEDGE, SKILLS, ABILITY ... + Strong computer skills required (Microsoft Office, Access) + Excellent verbal and written communication skills + Strong organization and time management skills + Ability to apply judgment independently, discretion in handling confidential information +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental… more
- Centene Corporation (New York, NY)
- …completion utilizing appropriate review criteria. Identifies and refers all potential quality issues to the Clinical Quality Management Department, and ... Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary...all potential quality issues and grievances to Clinical Quality Management and suspected fraud and… more
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** This job works collaboratively riskacross Highmark Health clinical areas to support clinical quality auditing, The ... policies, state, CMS, and federal regulations. This role serves as a clinical subject matter expert, providing insights and guidance to internal departments. The… more
- UPMC (Jamestown, NY)
- …of how quality and innovation impacts patient satisfaction, safety, and clinical quality outcomes. Identifies opportunities for improvement in the ... Medicine + Set the standards for the level and quality of care for the care delivery team +...initiative and seeks formal and informal opportunities to improve clinical practice. Seeks guidance and asks questions to continuously… more
- UPMC (Jamestown, NY)
- …of how quality and innovation impacts patient satisfaction, safety, and clinical quality outcomes. Identifies opportunities for improvement in the ... Medicine + Set the standards for the level and quality of care for the care delivery team +...initiative and seeks formal and informal opportunities to improve clinical practice. Seeks guidance and asks questions to continuously… more
- Centene Corporation (New York, NY)
- …provider practice patterns, and adequacy of benefit/payment components. + Identifies clinical quality improvement studies to assist in reducing unwarranted ... leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining… more
- Molina Healthcare (Albany, NY)
- …for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the ... clinical lead, the medical director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. +… more