- Evolent (Albany, NY)
- …Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing ... internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required. + Entering data into a proprietary system generating cases for both the medical and behavioral health reviewers. These requests may… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... appeal case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases,… more
- Molina Healthcare (Albany, NY)
- …appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership ... (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to...including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge.… more
- BronxCare Health System (Bronx, NY)
- …activities and monitoring on a quarterly basis and reports findings/analysis to Director . - Conducts educational/feedback sessions with UM staff related to ... order to prepare a response for submission in appeal. - In absence of Director , will review denial correspondence to determine validity of denial reason and course… more
- Catholic Health Services (Melville, NY)
- …the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician Advisors. Observes Catholic Health ... Physician Advisors and provide feedback for standardizing the Catholic Health Physician Advisor role across the system. Serves as a resource for Catholic Health Physician Advisors to provide guidance and assistance. Provides coaching to Catholic Health… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case Management to address ... potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques with members and...5 years. + Broad understanding of multiple areas (ie UM and CM). Incumbent is required to know multiple… more
- Evolent (Albany, NY)
- …and financial scope within Evolent Specialty Services. Reporting to the Director , Clinical Informatics, this role is responsible for acquiring, synthesizing, and ... and maintain the definitive source of truth for specialty Utilization Management ( UM ) agreements. This important work is achieved through collaboration across the… more
- Ellis Medicine (Schenectady, NY)
- …or send for insurance denials or quality improvement organization appeals. + Assists UM Coordinator with data entry of insurance authorizations and denials. + Denial ... MD to MD reviews. + Performs audit activities under the supervision of the Director of Case Management and Social Work Services. Ellis Medicine is committed to… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity and coordination ... + Case Management Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required to know multiple functional… more
- ULTRA ELECTRONICS OCEAN SYSTEMS INC. (Victor, NY)
- …front-end modules, and digital signal processing electronics. Reporting to the Director of Electrical Engineering, you would provide leadership that fosters ... project execution challenges + Ensure all staff and programs comply with UM US engineering processes, policies, and standards + Provide technical oversight and… more