- Humana (Albany, NY)
- …address identified gaps. They will work closely with established functions inside utilization management ( Medical Director , clinician decision making teams, ... thresholds and identify appropriate actions when controls indicate process gaps. + Review appeal overturns and provider complaints about coverage policies to make… more
- Arnot Health (Bath, NY)
- Job Description MAIN FUNCTION: Coordinates and manages with the Director of Nursing (DON) all nursing care activities based on the philosophy of Arnot Health using ... Maintains confidentiality while serving as a professional liaison. + Represents the Medical Center in a professional, courteous manner to patients, families and… more
- City of New York (New York, NY)
- …two (2) Psychiatric Nurse Practitioner for the roles below. Under the supervision of the Medical Director and of the Mental Health Director , with latitude ... evaluations with the referring agency and the client's caseworker. 2. Review all available clinically relevant material, including referral information, previous VPS… more
- Colliers Engineering & Design (Syracuse, NY)
- …goals, and plans for Department. + Implements decisions made by the Division Director . + Provides technical and management leadership to the Department. + Develops ... marketing program for Department Services in conjunction with the Division Director and Marketing Department. + Advises and assists professionals in other… more
- Access: Supports For Living (Middletown, NY)
- …with intellectual/ developmental disabilities. Working under the direction of an Assistant Director / Program Director / Regional Program Director they oversee ... maintained and ensure for timely billing, staff payroll processing and appropriate utilization of individual and agency funds. Providing individuals with the highest… more
- Villa of Hope (Rochester, NY)
- …providers, director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and when needed assists in ... SUPERVISORY POSITION JOB TITLE: Intake Coordinator- RN/ Evening DEPARTMENT/PROGRAM: Medical Services SUPERVISOR: Nurse Manager/Health Coordinator PAY GRADE: 82 FLSA… more
- City of New York (New York, NY)
- …Administration (HRA) which expedites access to essential benefits such as medical , social, financial, and vocational programs to more than 32,000 individuals ... Assess placements according to consumer need and preference; assist in the review and evaluation of housing facilities; compose and coordinate various housing and… more
- Kelly Services (Rochester, NY)
- …exception, and medical necessity reviews + Route cases to pharmacist/ medical director for final determination, as directed + Issue verbal ... and written notifications to members as required + Review and interpret prescription and medical benefit coverage (including Medicare D); document necessary… more
- CBRE (Albany, NY)
- …Effectively recommends same for direct reports to next level management for review and approval. Monitors appropriate staffing levels and reports on utilization ... **Financial Knowledge** Requires in-depth knowledge of financial terms and principles. Review and analyze complex financial/business analysis and reports prepared by… more
- CenterLight Health System (NY)
- …electronic/paper medical record, and any other clinical notes. + Review participants' charts for quality and address any deficiencies. + In collaboration ... religious backgrounds, and congenital or acquired disabilities. JOB RESPONSIBILITIES: + Review and ensure effective development and execution of personalized care… more