- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… 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...care to MCC in response to physician order, or review of updated clinical information Acts as a resource… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a...standard UM sources for potential inpatient medical necessity denials. Review patient class in the event manager ,… 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 ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Albany, NY)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… more
- Mount Sinai Health System (New York, NY)
- …+ Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager ... **Job Description** **RN/Case Manager MSH Case Management FT Days**...new admissions to identify patients where utilization review , discharge planning, and/or case management will… more
- Arnot Health (Elmira, NY)
- …to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... 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
- Guthrie (Binghamton, NY)
- …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... 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