- MVP Health Care (Tarrytown, NY)
- …continuous improvement. To achieve this, we're looking for a **Medical Director , Post-Acute Care Utilization Management ** to join #TeamMVP. If you have a ... At MVP Health Care , we're on a mission to create a...stay requests, and handling first-level appeals. + Collaborate with Utilization Management , Case Management , Quality… more
- Humana (Albany, NY)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Albany, NY)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... with prior experience participating in teams focusing on quality management , utilization management , case ...business metrics. + Experience working with Case managers or Care managers on complex case management , including… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …coding standards + Maintains current and working knowledge of Utilization Management Standards. + Experience in interpreting managed care benefit plans and ... customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough...and refers potential quality of care and utilization issues to Medical Director . + Utilizes… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! JOB SUMMARY: The System Director of Care Management (SDCM) is responsible for the strategic ... . Prepares and presents reports to executive leadership on care management performance and improvement plans. Ensures appropriate utilization of resources… more
- Centene Corporation (New York, NY)
- …skills in the review and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; ... system. + Identifies and refers potential cases to Disease Management , Case Management , Demand Management and Transitional Care . + Refers all potential… more
- Mount Sinai Health System (Long Island City, NY)
- …IR; Peds ICU, and APNs Pediatric Oncology depts.) Non-Bargaining Unit, 140 - Care Management - MSQ, Mount Sinai Queens **Responsibilities** 1.Reviews department ... **Job Description** The Director will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to… more
- Catholic Health Services (West Islip, NY)
- Overview The Director of Care Management is responsible for providing overall management of the Care Coordination department responsible for patient ... management including the Hub. Job Details The Director of Care Management : Works...Staff. Ensures compliance with Hospital Conditions of Participation. Implements care management programs, including utilization … more
- Evolent (Albany, NY)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
- Centene Corporation (New York, NY)
- …New York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality...coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. +… more