- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Medical Director , Post-Acute Care Utilization Management ** to join #TeamMVP. If ... continued stay requests, and handling first-level appeals. + Collaborate with Utilization Management , Case Management , Quality Department and other… more
- Stony Brook University (Stony Brook, NY)
- Director of Case Management **Position... Management leadership and staff functions related to case management and utilization management ... Summary** We are seeking a highly skilled and experienced Director of Case Management to...the design, development, implementation, and monitoring of the organization's case management and utilization review… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review...system. + Identifies and refers potential cases to Disease Management , Case Management , Demand … 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
- 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
- Guthrie (Binghamton, NY)
- …with strong care management , utilization review, and payer knowledge. A Case Management certification or obtain a Case Management certification ... case reimbursement. a) Identifies cost/clinical outlier patients for intensive case management and facilitates evaluation of alternative care options. b)… more
- Mount Sinai Health System (Long Island City, NY)
- …direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management ... Master?s degree in nursing or healthcare-related field **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous… more
- Guthrie (Corning, NY)
- …assigned. Has an understanding of the regulatory requirements relative to the case management process. Certified to complete Patient Review Instruments (PRIs). ... Has a working knowledge of the hospital computer system as it relates to case management . Essential Functions: 1. Assists to ensure that the right care is… 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