• Clinical Assessment Manager - Care Delivery

    CenterLight Health System (Flushing, NY)
    …of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably ... clinical onboarding and reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager… more
    CenterLight Health System (04/26/25)
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  • Clinical Manager - Integrated Care Perm…

    FlexStaff (New York, NY)
    …of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably ... during home visits. Utilizes Lenavi analyzer during either the review process and/or assessment. Documents all interactions and outcomes in the designated… more
    FlexStaff (04/18/25)
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  • Associate Medical Director, Cardiology

    Evolent (Albany, NY)
    …developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk- based models.** + Process ... role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a **Cardiologist** to… more
    Evolent (03/04/25)
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  • RN Uniform System Assessor field travel in…

    Molina Healthcare (Buffalo, NY)
    …the community and accessing and using durable medical equipment (DME). * Experience in utilization review , concurrent review and/or risk management a plus. * ... and revision of CHA paperwork and tasking tool documentation based on review and feedback provided through...RN candidate with a Uniform System Assessor (USA) or Home Care background. The candidate must have strong organization,… more
    Molina Healthcare (04/30/25)
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  • Perinatal & Early Childhood Mental Health Program…

    City of New York (New York, NY)
    …a portfolio of over 100 programs and supports a family-driven, individualized and strength- based approach to care. The portfolio includes the NYC Perinatal and Early ... CYF-DD collaborates with large DOHMH programs, such as: (a) The New Family Home Visits program that offers support, services and referrals to new and expectant… more
    City of New York (04/23/25)
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  • Telephonic UM Administration Coordinator

    Humana (Albany, NY)
    …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... must have ability to work Nights, Weekends and Holidays based on business needs. **Preferred Qualifications** + Bilingual English/Spanish...moving forward to next round of interviews. **Work at Home Guidance** To ensure Home or Hybrid… more
    Humana (05/11/25)
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  • Medical Director, Children's Services (SafetyNet…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …management rounds. + Provision of clinical oversight and leadership to Utilization Management/Case Management (UM/CM) staff working with the children's population. + ... and PH care across the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. + Collaborates with Provider Relations staff to ensure an… more
    Excellus BlueCross BlueShield (05/10/25)
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  • Care Coordinator II

    Spectrum Health and Human Services (Buffalo, NY)
    …as needed + Collaborate/coordinate with community base providers to support effective utilization of services based on client/family need. + Maintains complete, ... Care Coordinator will be responsible for the following outcomes: to reduce utilization associated with avoidable and preventable inpatient stays, to reduce … more
    Spectrum Health and Human Services (04/10/25)
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  • Health Insur & Auth Rep III

    University of Rochester (Rochester, NY)
    …written and verbal communication and customer service skills. **Financial Management** + Review each visit for insurance history by utilizing the hospital system ... Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain a… more
    University of Rochester (04/22/25)
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  • Corporate Medical Director - Medicare Grievances…

    Humana (Albany, NY)
    …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance organizations,… more
    Humana (04/24/25)
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