- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… 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 ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Molina Healthcare (Albany, NY)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies...(QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… 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 ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Humana (Albany, NY)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... health topics to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to… more
- Humana (Albany, NY)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Villa of Hope (Rochester, NY)
- …Ensures full participation of Tuckahoe staff in compliance, quality assurance, utilization review , and program evaluation activities. Maintains operating ... JOB TITLE: Clinical Director of Behavioral Health Residential & School Programs...of referral sources; monitoring of cycle time for referrals/admissions; utilization management; and documentation of services which aligns with… 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 ... in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… 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 ... in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- RiseBoro Homecare Inc. (Brooklyn, NY)
- …and influence therapeutic processes. The Functional Family Therapy- Adult (FFT-A) Director will be accountable for providing day-to-day support, leadership, and ... general supervision to Therapists and Case Managers. The FFT Director is responsible for maintaining adherence to the Functional...Assign cases to Therapists and Case Managers + Monitor, review , and approve all written work produced by FFT-A… more