- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of...with members of the healthcare team. + Proactively researches case findings related to payer audits of UM decisions… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- Guthrie (Binghamton, NY)
- …clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the ... , utilization review, and payer knowledge. A Case Management certification or obtaining a ...and community providers. a) Works closely with the Medical Director and other members of the healthcare team to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Essential Accountabilities: Level I + Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review ... assigned meetings including, but not limited to, weekly Medical Director staff meetings, weekly case consistency meetings,...case review determinations. + Provides input into the utilization management program policies and procedures. +… more
- Mount Sinai Health System (New York, NY)
- …admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using standardized criteria to achieve ... **Job Description** **RN/ Case Manager MSH Case Management...Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case … more
- Ellis Medicine (Schenectady, NY)
- …to Medicare beneficiaries per CMS Conditions of Participation at the direction of the Case Manager. * Utilization Management Activities; Collaborates with ... Case Managers and other team members for optimal Utilization Management information throughout the continuum. Maintains...support. Performs audit activities under the supervision of the Case Management Specialist and the Director… more
- Humana (Albany, NY)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of… more
- MTA (New York, NY)
- Deputy Director Enterprise Asset Management Value Realization Job ID: 6664 Business Unit: MTA Headquarters Location: New York, NY, United States ... - $175,000 HAY POINTS : 1096 DEPT/DIV: Strategic Initiatives \ Enterprise Asset Management SUPERVISOR : Director , Enterprise Asset Management LOCATION :… more
- Humana (Albany, NY)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more
- Humana (Albany, NY)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Case managers or Care managers on complex case management , including familiarity with social determinants...size of region or line of business. The Medical Director conducts Utilization Management of… more