- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director -Care Management Are you exceedingly driven, dedicated, and passionate about caring for your patients? Do you consistently create and nurture… more
- New York State Civil Service (NY)
- …2, Teacher 4 (and all parenthetics), Training Specialist 1 (Nursing), and Utilization Review Coordinator. Additional Comments * Please note that starting ... followed. The person will report to and perform other duties as determined by the Director of Quality Management . Will serve as an Administrator on Duty (AOD) on… more
- 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 ... drugs. Sign-on bonus eligible FUNCTION: To provide comprehensive clinical case management services that include: assessments; individual, group and family treatment;… 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 ... NY. In this role, you will provide comprehensive clinical case management services that include: assessments, individual, group and family treatment, treatment… 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
- 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
- Outreach Development Corporation (Brentwood, NY)
- …House Program Description + Facilitates case conferences, level of care assessments and utilization review in a timely manner and maintains record of old ... The Assistant Director /Clinical Coordinator is responsible for assisting the Site Director with the management of the administrative and clinical components… 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