- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - Friday, ... Days SUMMARY: Review all inpatient medical necessity denials for the health system based on...Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on… more
- Guidehouse (New York, NY)
- …appropriateness for inpatient level of care or observation services based on physician certification + Gathers clinical information to conduct continued stay ... utilization review activities with payers on a daily basis...of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee + Identifies, develops… more
- Guthrie (Binghamton, NY)
- …care services regarding admissions, case management, discharge planning and utilization review. Responsibilites: Reviews admissions and service requests within ... assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimburesement policy criteria. Provides case management and/or… more
- CDPHP (Albany, NY)
- …for a rewarding career. Established in 1984, CDPHP is a physician -founded, member-focused, and community-based not-for-profit health plan that offers high-quality ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical...This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse… more
- WMCHealth (Valhalla, NY)
- …business growth and objectives. This position plays an important role in ensuring physician support and execution of for Utilization Management and Documentation ... a resource for initial clinical reviewers. + Serves on UM Committee .Provides Physician administrative support and leadership to the utilization and resource… more
- Weill Cornell Medical College (New York, NY)
- Title: Senior Physician Assistant - Plastic and Reconstructive Surgery Location: Upper East Side Org Unit: Plastic and Reconstructive Surgery Work Days: ... trauma, cancer, and a wide range of elective cosmetic procedures. The Senior Physician Assistant functions as a senior level healthcare provider working under the… more
- Mohawk Valley Health System (Utica, NY)
- …hospitals objectives, and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides the team to ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job Summary The...correct level of care and reimbursement. Apply knowledge of utilization review, discharge planning, patient status changes, length of… more
- Catholic Health Services (Melville, NY)
- …department, and presents to Physician Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management (UM) committees. ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Nurse Practitioner or Physician Assistant will be responsible for providing obstetrical and gynecological patient care within the scope and ... outpatient patient population within a supervising practice agreement established with a specific physician on the staff of the Department of OB GYN, University OB… more