- Agiliti Health (NY)
- **POSITION SUMMARY** Create and deliver high-impact, customer-facing business- review presentations that clearly communicate Agiliti's value, service performance, and ... contract utilization trends. This role blends visual storytelling expertise with...AND RESPONSIBILITIES** + Design and produce facility- and division-level business- review decks that highlight service performance, spend trends, and… more
- Molina Healthcare (Albany, NY)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical … more
- Molina Healthcare (Yonkers, NY)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Garnet Health (Harris, NY)
- …for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. At Garnet Health, we are committed to ... Social Worker on our Emergency Department team at/in Garnet Health Medical Center-Callicoon. Responsibilities The Social Worker will be responsible for implementing… more
- Molina Healthcare (NY)
- …stay for requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide ABA/BHT services to Molina ... by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not… more
- Sedgwick (Albany, NY)
- …related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. ... Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and...+ Strong team and customer service orientation + Three Medical , and two dental plans to choose from. +… more
- Molina Healthcare (Albany, NY)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease ... productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical ...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- Molina Healthcare (Rochester, NY)
- …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... School of Nursing. **Required Experience** 3+ years hospital acute care/ medical experience. **Required License, Certification, Association** Active, unrestricted State… more
- Evolent (Albany, NY)
- …Physician Business Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization review ... of the Medical leadership team, providing timely medical review of service requests. Oversees the...needed for new hires to educate and train on Utilization management system and Field Medical Director… more