- Molina Healthcare (Buffalo, NY)
- …health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs ... - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- 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
- Healthfirst (NY)
- …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… 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
- Albany Medical Center (Albany, NY)
- …of three years clinical experience in an assigned service.* Recent experience in case management , utilization management and/or discharge planning/home ... Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for… 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 ... NYS Driver's License or Identification card.** **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)
- …controlling costs. The Director collaborates closely with medical staff, vendors, case management , and payers to secure payment and benefits for ... **Job Description** ** Director Pre Appeals Management -HSO Appeals ...in the state of employment required + Certification in Case Management (CCM, ACM) or Utilization… 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
- 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..., depending on the line of business. The Medical Director conducts Utilization Management or… 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
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