- CVS Health (Albany, NY)
- …in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Travelers Insurance Company (New York, NY)
- …investigating, evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims. Provides quality claim handling throughout the claim ... of policy information to facts or allegations of each case . + Work with Manager on use of Claim...as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent… more
- City of New York (New York, NY)
- …with patients, physicians and insurance companies to secure successful outcomes. Document complex medical information in our electronic medical record ... the BHS SUPERVISOR OF NURSES the successful candidate will maintain a comprehensive case management system for the BHS for Medical Qualification of Firefighter… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse Case Manager IIDepartment: Home Care Location: West Monroe Hours Per Week: 40Schedule: Days SUMMARY:The RN Case Manager is ... making changes in response to changing patient needs. The RN Case Manager identifies appropriate interdisciplinary services needed, coordinates those services and… more
- Elevance Health (Latham, NY)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Accountabilities: Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical cases. Interprets ... management, medical directors and legal, where appropriate, to ensure complex issues are addressed appropriately. + Prepares comprehensive summary reports and… more
- Bassett Healthcare (Cooperstown, NY)
- …+ Uses data collection tools to reflect activities, as noted by review of documentation + Provides community resource information as requested and facilitates ... date + Assists C3s with referrals; faxes and photocopies medical record information as needed for post-acute patient placement...to facilitate timely discharges + Support Unit C3s and Complex C3s with setting up transport, DME, and Follow-up… more
- Evolent (Albany, NY)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek… more
- City of New York (New York, NY)
- …and ongoing monitoring of program data. - Review and advise on complex cases and lead/participate in case conferences for cases involving complex ... the health and outcomes of adults and families with complex medical and behavioral health conditions residing...incidents data to identify clients in need; using DHS case management data, oversee and create analytical programs to… more
- City of New York (New York, NY)
- …for day-to-day tracking and coordination of complex and high-risk cases including case review , participation in case conferences, recording next steps ... to rapidly identify and intervene to support clients with complex behavioral health and/or medical issues who...organizations who serve DHS clients. As needed, conduct literature review on homeless health care and interventions targeted to… more