- Healthfirst (NY)
- **Duties//Responsibilities:** + **The Medical Peer Reviewer will assess// review requests for authorization, and claims payment, based on medical records and ... Peer Reviewer will:** + **Maintain productivity standards.** + **Collaborate with Utilization Management and Care Management and medical departments as needed,… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , ... state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria...hospital stay. The UR-CR 1 will collaborate with the medical team and the UR medical directors… more
- Centene Corporation (New York, NY)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
- Elevance Health (New York, NY)
- …impact:** + Perform physician -level case review , following initial nurse review , of Medical Oncology regimens and supportive care. + Perform physician ... maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate...board certified specialty. + Makes physician to physician calls to gather medical appropriate information… more
- WMCHealth (Valhalla, NY)
- …of quality and cost improvement that is data driven and develops systems to review utilization of resources and measure outcomes of care. Monitors physician ... + Works with leadership team to support clinical documentation integrity and utilization management at the Medical Center. Qualifications / Requirements: +… 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 ... for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- Calvary Hospital (Bronx, NY)
- …identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review , Discharge Planning, Risk Management, and Quality Assessment and ... 1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management...to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.… 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 ... and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more