- Molina Healthcare (Yonkers, NY)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more
- Molina Healthcare (Buffalo, NY)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Rochester Regional Health (Rochester, NY)
- …necessity in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay ... in the expected time frame and with most efficient utilization of resources. Carries out activities related to ...continuum. + Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based… 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 ... + Acts as a resource for the Respiratory Care Department in absence of supervisor, manager and director + Assists in full utilization of staff working time,… 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 ... and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- … manager 's supervisor, as needed, at the time of the annual performance review + Non-care manager support staff duties may include: + Requesting medical ... provides administrative support for any of the programs of Utilization Management, Behavioral Health, Quality Management, or Member Care...to the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. +… 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
- Molina Healthcare (Buffalo, NY)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies… more
- Bassett Healthcare (Little Falls, 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
- Bassett Healthcare (Cooperstown, 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