- Centene Corporation (New York, NY)
- …related to member care, provider interactions, and facilitates operations within utilization management. + Manages prior authorization, concurrent review , and ... have a New York RN license.** **Position Purpose:** Manages Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team to… more
- 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)
- …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 physician of...care to MCC in response to physician order, or review of updated clinical information Acts as a resource… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …and goal of sustaining high quality care/service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as ... needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you need: +… more
- Evolent (Albany, NY)
- …and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point...to determine if submitted requests require a prior authorization review or redirect as required. + Entering data into… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for coordinating cases… more
- CVS Health (Albany, NY)
- …we do it all with heart, each and every day. **Position Summary** This ** Utilization Manager ** position is with Aetna's Long-Term Services and Supports (LTSS) ... active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications** +… more
- Ellis Medicine (Schenectady, NY)
- …provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social ... SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for case management of assigned...in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly… more
- Arnot Health (Elmira, NY)
- …related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case ... of self and other case managers. f. The Case Manager tracks and trends LOS, resource utilization ,...Case Manager tracks and trends LOS, resource utilization , outliers, readmissions, denials, delay days and satisfaction of… 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** The Case...a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management… more