- Fresenius Medical Center (New York, NY)
- …address barriers to quality improvement. This includes promoting the adoption and utilization of Medical Advisory Board Recommended Algorithms and Standing ... quality improvement tools and electronic applications. + Performs desk review of facility Quality Assessment and Performance Improvement (QAPI) documentation… more
- Albany Medical Center (Albany, NY)
- …field of Clinical Social Work or Nursing with experience in Case Management, Utilization Review and Discharge Planning. * BLS Certification. * Demonstrated ... and may be considered Thank you for your interest in Albany Medical Center! Albany Medical is an equal opportunity employer. This role may require access to… more
- Arnot Health (Elmira, NY)
- …processes related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... the Physician Advisor and Team. DUTIES AND RESPONSIBILITIES: ** 1. Determines medical necessity and appropriateness of admission and stay in accordance with… more
- Highmark Health (Albany, NY)
- …The Senior Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal ... insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes… more
- Sedgwick (Albany, NY)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... and dosage, and monitor complex drug regimens; to provide medical necessity reviews to evaluate, implement, and monitor options...provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides… more
- SUNY Upstate Medical University (Syracuse, NY)
- …work with clinicians regarding patient deaths and completion of DAVE. Work with Utilization Review department to ensure correct patient class & status changes ... communication skills Ability to handle multiple priorities Knowledge of basic medical terminology Work Days: Primary shift of 6:45a-3:15p Tues-Sat with occasional… more
- Humana (Albany, NY)
- …Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA) + ... and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- Ellis Medicine (Schenectady, NY)
- …plan, implement and evaluate individual healthcare needs. Integrate Discharge Planning, Utilization Review and Performance Improvement activities at the patient, ... levels. Efficiently and effectively anticipates, identifies and resolves issues through utilization review and discharge planning processes. Collaborates with… more
- Catholic Health Services (Melville, NY)
- …Initiatives Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical ... York, as applicable. Certification by American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred. 4. Knowledge, Skills and… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more