- Arms Acres (Bronx, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
- Arms Acres (Carmel, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... appropriateness and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review … 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 ... policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques… more
- City of New York (New York, NY)
- …HPD's standards and maintain nondiscriminatory hiring and employment policies. As the Integrity Review Director , you would: - Oversee HPD's Integrity Review ... financial assistance from the Agency. Your Impact: As the Director of Integrity Review Unit, you will...- Make recommendations to executive management to optimize staff utilization and review throughput. - Analyze roadblocks… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of...+ Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge… more
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Humana (Albany, NY)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex ... care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical management review...size of region or line of business. The Medical Director conducts Utilization Management of the care… more
- Humana (Albany, NY)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus ... The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team… more
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