- Ellis Medicine (Schenectady, NY)
- …of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional information if the ... the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration... advisor when unable to resolve issues with attending physician + Documents thoroughly and accurately in medical… 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...to the payor, as needed, coordinating direct communication between physician and payor Medical Director as required.… more
- New York State Civil Service (Albany, NY)
- …on prioritization and areas to be addressed through collaborative review and utilization of available data.* Serve as physician advisor to OPWDD Medical ... nine Bureaus in need of the expertise of a physician including working with the Bureau Directors, the Division's...Medical Director of the Naloxone program.* Conduct ongoing review of OPWDD agency-wide policies and procedures.* Participate on… more
- Mount Sinai Health System (New York, NY)
- …Masters preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... 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
- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- 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
- Travelers Insurance Company (Albany, NY)
- …other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. + Stay apprised of ... influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State… 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 ... standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those...Home' policy Minimum Qualifications: + Must hold a NYS medical license as a physician board certified… more
- Elevance Health (New York, NY)
- …the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + Conducts ... **Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery** **Carelon Medical...peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines… more