- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... Management Standards. + Clinical skills are excellent and evidence- based medicine skills are such that the individual provides...+ Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge… more
- Mount Sinai Health System (New York, NY)
- …and coordination of services based on clinical needs and available resources. + Utilization Review : * Maintains a working knowledge of the UR requirements of ... **Job Description** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and… 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 ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Catholic Health Services (West Islip, NY)
- …of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource ... advice, and quality issues. Maintains knowledge of government regulations related to utilization review , transition planning, billing, and managing patients and… more
- Molina Healthcare (New York, NY)
- … management, risk management, risk adjustment, disease management, and evidence- based guidelines. + Experience in Utilization /Quality Program management ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Molina Healthcare (Syracuse, NY)
- … management, risk management, risk adjustment, disease management, and evidence- based guidelines. + Experience in Utilization /Quality Program management ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Mount Sinai Health System (New York, NY)
- …coordination of services based on clinical needs and available resources. 3. Utilization Review : a. Maintains a working knowledge of the UR ( Utilization ... Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager… 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 ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Mount Sinai Health System (New York, NY)
- …care and coordination of services based on clinical needs and available resources. Utilization Review : + Maintains a working knowledge of the UR requirements ... Masters preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. +… more
- Albany Medical Center (Albany, NY)
- …a changing environment. + Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure ... in an assigned service - required + Recent experience in case management, utilization management and/or discharge planning/ home care in a high volume, acute… more