- Catholic Health Services (Melville, NY)
- … system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the ... Overview Catholic Health is one of Long Island's finest ...knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation.… more
- University of Rochester (Rochester, NY)
- …individual, and internal equity considerations._ **Responsibilities:** Provides comprehensive mental health and/or dual diagnosis services for individuals who have a ... trauma, OCD, complex mood and anxiety disorders, as well as individuals seeking mental health care with a provider in a comfortable setting and with the flexibility… more
- CenterWell (Clifton Park, NY)
- …care patient services provided by clinical personnel. This role is a focused on both home health clinical quality assurance and home health clinical ... available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet… more
- Humana (Albany, NY)
- …management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience ... on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation).… more
- Catholic Health Services (Melville, NY)
- … system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the ... Overview Catholic Health is one of Long Island's finest ...during, and after a patient's visit/stay. For scheduled services, review and analyze patient visit information to determine whether… more
- Evolent (Albany, NY)
- …Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. + Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... final resolution and adjudication, including refund of credits + Review and advise supervisor or manager on trends of...western New York, Rochester is our namesake and our home . One of the world's leading research universities, Rochester… more
- Evolent (Albany, NY)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Albany, NY)
- …is preferred + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Amgen (New York, NY)
- …on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI). + Act as an extension of the HUB, ... through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested… more