- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Molina Healthcare (Buffalo, NY)
- …unrestricted State RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified ... licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of training… more
- Guthrie (Binghamton, NY)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
- Ellis Medicine (Schenectady, NY)
- …beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . * Utilization Management Activities; Collaborates with Case Managers ... to make post discharge arrangements for patients. Assists Case Manager or Social Worker by offering choice of providers....and other team members for optimal Utilization Management information throughout the continuum. Maintains… more
- Ellis Medicine (Schenectady, NY)
- …Discharge Planner's primary function is to work with the Social Worker, Nurse Case Manager , or Utilization Management Nurse to facilitate patient discharge ... per CMS Conditions of Participation at the direction of the Case Manager . + Utilization Management Activities: + Collaborates with Case Managers and other… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- New York State Civil Service (New York, NY)
- NY HELP No Agency Empire State Development, NYS Title Project Manager , Utilization - MWBE Occupational Category Other Professional Careers Salary Grade NS ... the direct supervision of the Director of Contract Participation, the Project Manager , Utilization , will lead the planning, execution, and monitoring of… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ourSyracuse ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required. +… more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization /appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors and/ ... and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
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