- Bassett Healthcare (Cooperstown, NY)
- …secures financial and human resources for the department. Oversees and works with the Director of Utilization Management to support and implement the goals ... director is responsible for the oversight of case management and logistics activities for the Bassett Healthcare Network...of the utilization management program. Maintains oversight responsibility for… more
- Humana (Albany, NY)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Albany, NY)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Albany, NY)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... with prior experience participating in teams focusing on quality management , utilization management , case ...management operational improvements, including those within the medical director area + Participate in call rotation + Develop… more
- Samaritan Daytop Village (Queens, NY)
- …and agency administration. The Program Director will be responsible for census/ utilization management and quality assurance. What You Will Do + Supervise ... Community is Everything Help LEAD Yours! LCSW Program Director -OASAS Facility Staten Island Social Workers, psychotherapists and mental health professionals can work… more
- Molina Healthcare (Buffalo, NY)
- …experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that authorization… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… 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 ... Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior… more
- Cognizant (Albany, NY)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' ... submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... to service requests. Works closely with leadership and Medical Director on member requests. This role is responsible to...unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience… more