- Excellus BlueCross BlueShield (Rochester, NY)
- …Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health, Quality Management , or Member ... as needed, at the time of the annual performance review + Non-care manager support staff duties...under pressure. + Demonstrates proficiency in basic navigation and utilization of department specific applications: care management … more
- Rochester Regional Health (Rochester, NY)
- …in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay reviews ... efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other… more
- Elevance Health (New York, NY)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually… more
- Bassett Healthcare (Little Falls, NY)
- …to staff regarding "new" therapeutic modalities and medications (measured by leadership review ) + Assists supervisor, manager and director in training of ... and continuing education of current employees (measured by peer review and management observation) + Acts as...for the Respiratory Care Department in absence of supervisor, manager and director + Assists in full utilization… more
- CenterWell (Albany, NY)
- …of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review of the care received by members in an assigned region, ... practice management . + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid, or… more
- Catholic Health Services (West Islip, NY)
- …+ Ensures compliance with Hospital Conditions of Participation. + Implements care management programs, including utilization review , intake and discharge ... hospital care management leadership role is required. + Experience in utilization management , working with managed care organizations, and discharge planning… more
- Molina Healthcare (Buffalo, NY)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Highmark Health (Albany, NY)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create...**Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management … more
- Bassett Healthcare (Delhi, NY)
- …no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. + Analyzes assessment data ... no more than 2-3 exceptions, as measured by random supervisory chart review and/or direct supervisory observation. + Identifies expected outcomes individualized to… more
- University of Rochester (Rochester, NY)
- … Management ** **Billing and Reports** + Collaboration with Dept. Billing Manager regarding billing operations procedures + Analyze, review and distribute ... work with staff on resolving discrepancies. + Utilize Tableau reports for operations, utilization , and revenues. + Build/edit and review reports for various… more