- FlexStaff (New York, NY)
- …complete, accurate, including and not limited to enrollment, disenrollment, electronic/paper medical record, and any other clinical notes. Review participants' ... religious backgrounds, and congenital or acquired disabilities. JOB RESPONSIBILITIES: Review and ensure effective development and execution of personalized care… more
- UHS (Johnson City, NY)
- …clerical work + Previous experience in data processing + Certified home care and/or utilization review work experience Why You'll Love Working at UHS At United ... skills and a thorough understanding of insurance requirements. You'll review clinical documentation to confirm it meets agency and...Comprehensive Benefits for Life & Family - We offer medical , dental, and vision coverage starting the first of… more
- WMCHealth (Valhalla, NY)
- …experience in a hospital setting, preferably cardiology, radiology, surgery or utilization review , required. Previous revenue integrity experience, Excel and ... claim edits involving any type of clinical or coding review or required modifier based on services rendered. +...Electronic Medical Records experience preferred. Education: Graduate of an accredited… more
- Sodus Rehab & Nursing Center (Utica, NY)
- …of concurrent review . + . Coordinate with Social Services and Medical Department to obtain clinical notes & social work documentation to compile concurrent ... review package. + . Submitting concurrent review package and follow up with Utilization ...(Required) Experience: + Customer service: 1 year (Required) + Medical terminology: 1 year (Required) + Computer skills: 1… more
- WSP USA (New York, NY)
- …promoting their professional development. Track and manage team financial KPIs and utilization goals. Manage backlog and staff workload. + Recruit/hire staff and ... project meetings, public meetings, and professional conferences/meetings. + Perform and review work products developed and prepared by junior staff, including dam… more
- BronxCare Health System (Bronx, NY)
- …assist the department's leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify ... and Medical Audit Contractors, and other licensing, accrediting, or review agencies. -Keeps current on concepts, techniques, and methods relative to areas… more
- MVP Health Care (Rochester, NY)
- …of quality cost effective care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. + Contribute ... **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning,… more
- Molina Healthcare (Rochester, NY)
- …the professional scope of a Payment Integrity Clinician. This includes assessing medical documentation, itemized bills, and claims data to ensure appropriate payment ... levels, optimize resource utilization , and maintain compliance with state and federal laws....accepted coding criteria, established guidelines, and relevant payment and medical policies, with a consistent focus on promoting the… more
- City of New York (New York, NY)
- …court proceedings for guardianship and other legal interventions. - Consult with the Medical Director regarding utilization off MHL Section 9.37 authority. - ... disability benefits. CAS manages contracts that serve individuals and families with medical , mental health, and/or substance use disorders. CAS programs also provide… more
- Amgen (New York, NY)
- …through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested ... Offer office education during the access process, including formulary coverage/ utilization management criteria, insurance forms & procedures, benefits investigation,… more