- Molina Healthcare (Buffalo, NY)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs… more
- Monte Nido (White Plains, NY)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... for people to realize their healthy selves. **Eating Disorder Clinical Director ** **Monte Nido Eating Disorder Center of Westchester** **White Plains, NY**… more
- Stony Brook University (Stony Brook, NY)
- …Coordinator: investigates issues and presents findings and recommendations to Associate Technical Director SL-5, as assigned. + Conducts monthly review of ... Laboratory sections). Under the direction of TH Assoc Technical Director , she /he will be responsible for oversight of...and LIS (Clinisys & CoPath) order entry and result review screens, new tests additions to the test menu,… more
- 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
