- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- Summary The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization Statistical ... care delivery model. - Coordinates with the patient care team to review clinic appointment availability/ utilization to ensure that clinic schedules are… more
- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Albany, NY)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- Highmark Health (Albany, NY)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more
- Elevance Health (New York, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Medical Director** _Please note that per our policy...reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and… more
- WMCHealth (Valhalla, NY)
- …continuous education to physicians as needed on payor policies and workflows. + Utilizes medical review guidelines and parameters to assure consistency in the ... management areas of Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. + Reviews cases… more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… more
- Mount Sinai Health System (New York, NY)
- …**Experience Requirements** + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. ... a Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management...Supports the mission, vision, philosophy and goals of the Medical Center. + Case Management: The CM process will… more
- Northwell Health (Staten Island, NY)
- …case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. + Keeps ... concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness of admission and continued length of stay. + Contacts… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Quality Management/ Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH committees for ... and community standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those cases in accordance… more