- MVP Health Care (Rochester, NY)
- …to confidentiality. + Ability to make independent decisions regarding resource utilization , and quality of care. + Must demonstrate understanding of clinical ... hospital discharge staff, the Care Manager will identify the medical and psychosocial needs of members, function as a...care. + The Care Manager will also monitor and review cases with the appropriate provider and on-site clinical… more
- Molina Healthcare (NY)
- …teams that support one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, ... health plan supervisory experience. Managed Care operations experience. Prior Medical Assistant experience. **Preferred License, Certification, Association** n/a To… more
- Humana (Albany, NY)
- …meet required timelines. + Submits required documents to state agencies for review and approval. + Regularly meet with Humana Healthy Horizons Medicaid markets ... operations, such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. **Work… more
- Global Foundries (Malta, NY)
- …extended periods of time (> 2 hours) Preferred Functions - Skills: + Review Statistical Process Control charts for process quality and react to Out-of-Control ... Paid time off (PTO) and paid holidays + Multiple competitive options for medical , vision, and dental insurance plans + Company matched 401(k) retirement savings… more
- BAE Systems (Endicott, NY)
- …a team of program quality engineers to accomplish the following: + Review and assess customer/contractual quality requirements for compliance and coordinate with ... to achieve common goals. + Has experience managing department budgets and utilization **Required Education, Experience, & Skills** + Bachelor's Degree and 12 years… more
- CVS Health (Ballston Spa, NY)
- …and labeling. + Check for appropriateness of therapy through prospective drug utilization review including assessment for appropriateness of therapy, high risk ... to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and… more
- Elevance Health (Latham, NY)
- …of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment ... providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires BA/BS in… more
- Cardinal Health (Albany, NY)
- …adequately staffed and supported. + Track and report on project progress, resource utilization , and other key metrics to ensure the research team is operating ... for relevant segments a plus - eg consumer, pharmacy, medical , health plans, logistics, etc. **Anticipated salary range:** $103,500...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- National Express (White Plains, NY)
- …a timely manner. + Documents and manages customer or employee complaints and review customer survey data + Responsible for knowledge of CSC contracts and ... all expenditures in accord with company guidelines. + Ensures the effective utilization of vehicles. + Exhibits the highest ethical best practices and personal… more
- Maritz (New York, NY)
- …Matter Expert (SME) of various programs to drive program engagement and utilization . + Conduct engaging presentations or demos, both virtually and in-person, using ... escalate issues/concerns as necessary according to the program plan. + Consistently review status of performance metrics using program analysis, data and tracking. +… more