- Deloitte (New York, NY)
- …registered nurse, physician, physician assistant, case manager, clinical documentation specialist , utilization review , informatics RN, Quality, DRG ... Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
- Northwell Health (New Hyde Park, NY)
- …responsible for the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug ... to match formulary intent. This role involves critical evaluation of clinical literature, pharmacoeconomic data, and regulatory requirements to support P&T Committee… more
- Rochester Institute of Technology (Rochester, NY)
- **9779BR** **Position Title:** Senior Clinical Staff Specialist **Organization:** Student Health Center **Job Responsibilities:** + Patient Care Services & ... from clinical providers, pursue insurance authorization for medications, imaging and specialist referrals as required. + Clinical referral process + Use the… more
- J&J Family of Companies (New York, NY)
- …United States **Job Description:** We are searching for the best talent for Sr. Clinical Specialist to be in New York City/Northern New Jersey area. **About ... to wellness. Learn more at https://www.jnj.com/medtech **Core Job** **Responsibilities:** + The Clinical Specialist reports to the Regional Sales Manager (RSM)… more
- Northwell Health (Melville, NY)
- …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective ... clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have experience with Milliman… more
- Northwell Health (New Hyde Park, NY)
- …Number** 164980 Job Description Implements, coordinates, and evaluates all clinical Pharmacy services. Assists and directs Medication Usage Evaluations, collaborates ... Job Responsibility + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy,… more
- Northwell Health (Melville, NY)
- …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective ... utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness of… more
- Northwell Health (Manhasset, NY)
- …of clinical services. Includes but not limited to: medication review and reconciliation, dosing recommendations, pre and post transplant management of ... transplant pharmacy team to implement, coordinate, and evaluate all clinical transplant pharmacy services. Collaborates with the multidisciplinary medical staff… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria… more
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