- BronxCare Health System (Bronx, NY)
- …assist the department's leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify ... and Medical Audit Contractors, and other licensing, accrediting, or review agencies. -Provides regular and special reports, in writing and verbally, regarding… more
- Mount Sinai Health System (New York, NY)
- …The Clinical Program Manager, Clinical Command Center is a Registered Professional Nurse, Physician Assistant, or Nurse Practitioner, who manages the 24 hour a day ... patient-centered care. **Qualifications** Must be a Licensed Registered Nurse, Physician Assistant or Nurse Practitioner Registered Nurse Bachelor?s Degree in… more
- Nuvance Health (Poughkeepsie, NY)
- …Degree or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work ... Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary...New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading… more
- Northwell Health (Melville, NY)
- …level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective ... medical necessity for assigned case. + Collaborates with physician advisor, payor representative and site case managers to...4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have… more
- Catholic Health Services (Roslyn, NY)
- …and monitors staff satisfaction. + Assures compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, ... reporting data on utilization trends, resource utilization and denials. + Serves as a resource to...and denials. + Serves as a resource to physicians, physician advisors, CM department, and hospital staff. + Collaborates… more
- CenterWell (Westbury, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- UHS (Vestal, NY)
- …the highest standards of patient care through effective resource coordination and utilization . In this role, you'll collaborate with clinical teams to manage ... and make every connection count. Primary Department, Division, or Unit: UHS Physician Practice Management Primary Work Shift: Day Regular Scheduled Weekly Hours: 40… more
- Deloitte (New York, NY)
- …physician , physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and health IT ... performance and reputation. Required Qualifications: + Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered… more
- University of Rochester (Rochester, NY)
- …Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records, ... Identifies problems that include but are not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal… more