- MVP Health Care (Rochester, NY)
- …State Licensure as a Registered Nurse required with at least 4 years of recent clinical and Care Management experience. + Certification in Case Manager (CCM) is ... + Demonstrated clinical knowledge including an understanding of population health management and the care management process. + Experience with situations… more
- Bassett Healthcare (Cooperstown, NY)
- …responsibility of strategic planning, clinical operations, financial and human resource management , program development, management and promotion, and ... Department of Nursing Leadership Team. * In collaboration with clinical chiefs and executive management teams to...pursue the mission, vision and network strategic objectives. Financial Resource Management Involved and or responsible for… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as resource to Utilization Management staff, members ... management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient...are no gaps in care. + Acts as a resource and liaison to the provider community in conjunction… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and evidence-based medicine ... Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member care management , and medical… more
- New York State Civil Service (Webster, NY)
- …as a Family Care Program, Mobile Integration Team, and outpatient clinic; perform clinical case management activities; serve as a member of an interdisciplinary ... treatment team; and provide nursing-specific clinical , consultative, and instructional assistance to individuals and their families, other disciplines, and health… more
- New York State Civil Service (Syracuse, NY)
- …In addition to assessment and treatment, your duties may include: clinical leadership; program management ; forensic or court-ordered assessment, treatment ... also perform the following duties: supervise psychological services provided by clinical staff; evaluate information from mental health units, probation, parole,… more
- Humana (Albany, NY)
- …of the managed care industry, Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience ... put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D...complex to complex appeals for coverage for drugs using resources outlined above as well as inter- and intra-departmental… more
- Centene Corporation (New York, NY)
- …community resource connection activities including connecting members to community resources to support their care management journey and provide necessary ... in a cost-effective manner. Provides members with known community resources and works with the care team to identify...of a successful community connection + Works with care management team on escalating community resource requests… more
- Mount Sinai Health System (New York, NY)
- …healthcare provider analytics related to revenue modeling, managed care contracting, population management , case management , clinical or financial decision ... 1. Analyzes data requests using information technology, enrollment, claims, pharmacy, clinical , contract, medical management , financial, administrative and other… more
- Outreach Development Corporation (Brentwood, NY)
- …primary duties and responsibilities include, but are not limited to: + Provide clinical case- management supervision to case managers of the Community Residence. ... access to specialized services eg Mental, Health, Social Security Disability, Veteran's Resources , etc. + Assist in facilitating access to job training, job search… more