- Nuvance Health (Carmel, NY)
- …years RN experience in an acute care setting; Leadership experience preferred; Utilization review , discharge planning or case management experience preferred. ... in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care… more
- Centene Corporation (New York, NY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Molina Healthcare (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
- Molina Healthcare (Syracuse, 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
- Trinity Health (Troy, NY)
- …requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse , physicians, staff and ... identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified… more
- Bassett Healthcare (Cooperstown, NY)
- …a principle liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate ... any urgent needs to IP CM/SW Utilization Review : Complete admission review for medical...and level of care matches order Collaborates with UM Nurse to assure that all payor and status requirements… more
- Sedgwick (Albany, NY)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...required to include one (1) to three (3) years utilization review experience and three (3) years… 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 ... provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. +...standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those… 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