- Healthfirst (NY)
- …maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + ... closely with other Operations leaders including but not limited to Care Management , Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to… 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 ... and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work...and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a… more
- Humana (Albany, NY)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately..., depending on the line of business. The Medical Director conducts Utilization Management or… 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 ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of ... we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of... review determinations. + Provides input into the utilization management program policies and procedures. +… 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. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- CUNY (New York, NY)
- Director of Facilities Planning and Operations - Facilities Management **POSITION DETAILS** The CUNY School of Medicine (CUNY SoM) located in the heart of ... student body. Under the supervision of the Chief Operating Officer (COO), the Director of Facilities Planning and Operations will provide direction and daily … more
- City of New York (New York, NY)
- …initiatives, and the implementation of integrated systems that govern real estate asset management and space utilization . The Director leads a profession ... and other building services, health/safety program coordination, lease and property management , land use and environmental review activities, contract… more