• Case Manager (Inpatient Units)

    Ellis Medicine (Schenectady, NY)
    …in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly preferred. Home care, payer, or ... services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and… more
    Ellis Medicine (04/25/25)
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  • Field Medical Director , Radiology (Urology)

    Evolent (Albany, NY)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (05/03/25)
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  • Field Medical Director, Pain Management

    Evolent (Albany, NY)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Management, 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
    Evolent (04/12/25)
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  • Appeals Licensed Practical Nurse

    Evolent (Albany, NY)
    …business needs of the particular health plan. * Research requests for post-determination review and categorizes each for processing based on the applicable ... You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
    Evolent (05/10/25)
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  • UM RN

    Centers Plan for Healthy Living (Queens, NY)
    …various other providers and support involved in the member's care. + Provides utilization review for preauthorization, concurrent and discharge reviews and post ... home to improve their quality of life. The Utilization Management nurse will assess and process all authorization...service review + Apply medical necessity guidelines based … more
    Centers Plan for Healthy Living (04/15/25)
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  • ServiceNow Knowledge Analyst - US Based…

    Anywhere Real Estate (New York, NY)
    …product managers, engineers, and business owners to ensure effective management and utilization of knowledge assets. You will ensure that Anywhere maintains the ... Oversee all stages of the knowledge management lifecycle, including creation, review , publication, and retirement of knowledge assets. + **Collaboration:** Partner… more
    Anywhere Real Estate (04/12/25)
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  • Clinical Reviewer, Occupational Therapy

    Evolent (Albany, NY)
    …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job ... Reviewer you will be a key member of the utilization management team. We can offer you a meaningful...needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not… more
    Evolent (05/08/25)
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  • Clinical Reviewer, Physical Therapy

    Evolent (Albany, NY)
    …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
    Evolent (05/08/25)
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  • Homeownership Counselor

    Community Housing Innovations (White Plains, NY)
    …and review all required pre-closing documents: mortgage loan commitment, home inspection report, HUD Planner's scope of work, 1003, purchase contract, title ... update on a weekly basis + Prepare quarterly compliance reports for NYS ( GUS web- based system) + Assists with annual HOME Monitoring mailing lists and letters,… more
    Community Housing Innovations (05/09/25)
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  • Senior Director of Pull-Through Strategy

    Bayer (NY)
    …to maximize HP/PBM Pull Through opportunities; + Special emphasis on consistent utilization of DRPAs as conduit to field sales action, and opportunity Assessment; ... implement appropriate tools to help teams monitor trends and utilization of patient support services and utilization ...and field sales insights; + Conduct a comprehensive retrospective review every 90 days to evaluate progress towards goals… more
    Bayer (05/02/25)
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