- Evolent (Albany, NY)
- …LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. ... the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and ...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Molina Healthcare (Albany, NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Catholic Health Services (Melville, NY)
- …Physician Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician ... Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation.… more
- Ellis Medicine (Schenectady, NY)
- …patient through the continuum. + Maintains accurate, up-to-date documentation in the medical record. + Documents Utilization Management activities in MIDAS per ... function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge plans, support coordination of care… more
- Evolent (Albany, NY)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management ( UM ) agreements. This important work is achieved through ... and financial scope within Evolent Specialty Services. Reporting to the Director , Clinical Informatics, this role is responsible for acquiring, synthesizing, and… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …mandatory trainings as required. + May be required to attend Fair Hearings with Medical Director relating to specific cases. + Works independently, as well as ... Community Health Assessment (CHA) Tools to determine functional status, medical , behavioral, psychological, and community resource needs for coordinating,… more