- Northwell Health (Melville, NY)
- …Review standard and regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical ... responds to Corporate Compliance Audits and serves as a resource for the Health System. Reviews denial trends and...Preferred Skills 3-5 years experience in Utilization Review, Case Management , and Clinical Appeals. 3-5 years of… more
- CCSI INC (Rochester, NY)
- …this program. TheClinical Mental Health Court Navigatorrole blends elements of case management and clinical assessment skills to ensure participants receive ... Clinical Mental Health Court Navigator Rochester, NY (http://maps.google.com/maps?q=1099+Jay+Street+Rochester+NY+USA+14611) * Monroe County Office of Mental Health… more
- Trinity Health (Albany, NY)
- …compassionate and transforming healing presence within our communities. **POSITION SUMMARY** The Clinical Risk Management Analyst is responsible for the overall ... patient safety and clinical risk management functions related to review...+ Is readily available to all staff as a resource . + Competent with data display and analysis +… more
- City of New York (New York, NY)
- …to shelter providers to improve qualitative and quantitative data entry. - Create a clinical quality management program in collaboration with other Staff in the ... Services (DHS) is comprised of the administrative units of the NYC Human Resources Administration (HRA) and the Department of Social Services (DSS). The city… more
- Humana (Albany, NY)
- …+ Experience advocating for managed care members at all levels of care. + Non- clinical Case Management experience + Call Center Experience + Experience working ... so they can achieve and/or maintain an optimal wellness state. The Care Management Support Professional contributes to administration of care management in… more
- Mount Sinai Health System (New York, NY)
- …regular quality assurance checks to identify and mitigate risks. **Financial and Resource Management :** + Develop and manage budgets, ensuring cost-effective use ... project management , and team leadership. + Progressive managerial and clinical job related experience specific to area of responsibility. + Experience in… more
- Evolent (Albany, NY)
- …Are 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, ... discussions with treating providers to ensure appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and … more
- Guthrie (Binghamton, NY)
- …throughout shift. B. Serves as an advocate for patients and family in the clinical management of care. C. Effectively promotes and demonstrates ability in ... management of patient care, human, fiscal and material resources and the total environment of the nursing unit....and autonomy in nursing practice. E. Acts as a resource regarding clinical , administrative aspects of patient… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …guidance and leadership to the daily activities of the Case Management Department clinical staff. Acts as resource to Case Management staff, members, and ... care cost drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case … more
- Villa of Hope (Rochester, NY)
- …services they may enroll in at Villa of Hope (Clinic, Health Homes/Care Management , etc.). The Clinical Director operates these programs in alignment with ... JOB TITLE: Clinical Director of Behavioral Health Residential & School...to reach their full potential. Leading Others + Process Management : Develop and monitor processes and organize resources… more