- Northwell Health (Staten Island, NY)
- …management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred. + Keeps ... in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team. + Serves as a resource to the health … more
- Arnot Health (Elmira, NY)
- …related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case ... and stay in accordance with Interqual. ** 2. Prepares Medicare /Non Medicare hospital notices of noncoverage (HINN)...In conjunction with the patient/family, other members of the health care team, the payer, and available resources, formulates… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …professional and community standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those cases in ... and support for the development and implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has… 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 ... resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of...reports:- - - 2nd insurance level report - - Medicare and Medicaid credit balance report - - Over… more
- Humana (Albany, NY)
- …management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience ... focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient… more
- Lakeview Health Services (Geneva, NY)
- …+ Complete duties in accordance with the guidance issued by the Office of Mental Health specific to C&Y Health Home Non-Medicaid Care Management. Experience, ... + Employee Assistance Program (EAP) + Tuition Assistance Agency Overview Lakeview Health Services is a premier partner throughout the Finger Lakes region, providing… more
- CenterWell (Albany, NY)
- … Advantage/ Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual **Use your skills to make an impact** **Alert** ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… 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 ...knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation.… more
- Saratoga Hospital (Saratoga Springs, NY)
- …systems (ideally EPIC and OnBase) and a basic understanding of Patient-Centered Medical Home (PCMH) and Centers for Medicare and Medicaid Services (CMS) quality ... Health Information Specialist (HIM Specialist) Location: Saratoga Hospital,...accordance with departmental policies and procedures. + Perform thorough review of all incoming documents via mail, fax, email,… 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