- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Perform medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identify utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- WMCHealth (Valhalla, NY)
- …of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester Medical Center. Depending ... Asst Utilization Coordinator Company: Westchester Medical Center...of which must have been in the area of utilization review , quality assurance, risk management or… more
- Catholic Health Services (Melville, NY)
- …Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of...care to MCC in response to physician order, or review of updated clinical information Acts as a resource… more
- Guidehouse (New York, NY)
- …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and...policies and timelines + Adheres to CMS guidelines for utilization reviews as evidenced by utilization of… more
- Humana (Albany, NY)
- …conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization , and identifying unusual ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format**… more
- Molina Healthcare (Albany, NY)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- University of Rochester (Rochester, NY)
- …work is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent acute hospital ... Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: Range: UR URCB 213 Compensation Range: $69,326.00 -… more
- Mount Sinai Health System (New York, NY)
- …State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts + Obtains/Prepares Medical Records and other documentation ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...record keeping. Responsible for accurate filing of records, obtaining medical records and mailing of both internal and external… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more