- Highmark Health (Albany, NY)
- …Proven ability to deliver engaging and informative product demonstrations and walkthroughs. + ** Utilization Management & Clinical Expertise:** + Utilization ... Management Knowledge: A strong understanding of utilization management principles, processes, and industry best practices. + Clinical Knowledge: Familiarity… 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
- Phoenix House (Wainscott, NY)
- ** Utilization Review Manager ** **Job Details** **Job Location** East Hampton Residential - Wainscott, NY **Position Type** Full Time **Education Level** Graduate ... Morning **Job Category** Nonprofit - Social Services **Description** **SUMMARY** The Utilization Review (UR) Manager coordinates commercial, and Medicaid Managed… 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
- Molina Healthcare (NY)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
- Arnot Health (Elmira, NY)
- … of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager 's average ... BSN prepared will be a leader in the Case Management practice. The Case Manager will work...nursing in acute care hospital setting or two years utilization management in an acute care hospital… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... accommodation is granted as required by law._ " The ** Utilization Management Representative II** is responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… 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