- 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
- 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...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… 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
- New York State Civil Service (Orangeburg, NY)
- …departments assigned to the Quality Management Program - program evaluation, risk management , utilization review , health information management , and ... HELP No Agency Mental Health, Office of Title Deputy Director , Psychiatric Center 1 - Quality Management ,...clinical risk management , standards compliance, survey readiness, utilization review , or a closely related area;… more
- MTA (New York, NY)
- Deputy Director Enterprise Asset Management Value Realization Job ID: 6664 Business Unit: MTA Headquarters Location: New York, NY, United States ... - $175,000 HAY POINTS : 1096 DEPT/DIV: Strategic Initiatives \ Enterprise Asset Management SUPERVISOR : Director , Enterprise Asset Management LOCATION :… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical management...Performs medical review activities pertaining to utilization review… 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...Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of… more