- Evolent (Albany, NY)
- …contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Utilization ... Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing… more
- Molina Healthcare (Albany, NY)
- …or State Clinical Social Worker/Counseling (or related field) License Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified ... for RN, LVN, or bachelor's trained candidates with a strong background in Utilization Management . Additionally, the applicant should have proven experience as a… 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 our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- Catholic Health (Buffalo, NY)
- …Holiday Rotation Hours: 8:00 am to 4:00 pm Summary: The Registered Nurse (RN) Care Manager - Utilization Review, as an active member of the Care Management and ... foundational nursing clinical skills and discharge planning principles, the RN Care Manager , Utilization Review collaborates with the interdisciplinary team to… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: 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...as liaison between the Utilization and Appeals Management Department and the physician of record, as required.… more
- Rochester Regional Health (Rochester, NY)
- …the quality of care. The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate ... Job Title: Care Manager (RN) - Center for Refugee Health Location:...* 3 years of acute hospital care, Nursing, Case Management , or Utilization Management experience… 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
- Molina Healthcare (Rochester, NY)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... selected for this position must be licensed in both states.** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an ... utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum...a. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management … more
- Guthrie (Binghamton, NY)
- …five (5) years of experience in an acute care setting with strong care management , utilization review, and payer knowledge. A Case Management certification ... Position Summary: The Acute Case Manager utilizes industry accepted processes for achieving optimal...members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria.… more