- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …Part II, Appendix G. The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- CDPHP (Albany, NY)
- …plans. This will include researching new and emerging technologies and interfacing with the medical directors, utilization review staff, and other key policy ... for a rewarding career. Established in 1984, CDPHP is a physician -founded, member-focused, and community-based not-for-profit health plan that offers high-quality… more
- University of Rochester (Rochester, NY)
- …Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records, ... GENERAL PURPOSE Leads team, including supervisors, that reviews referrals for medical necessity and appropriateness of level of care. Assists patients with… more
- Northwell Health (Manhasset, NY)
- …projects and research. + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, ... transplant pharmacy services (inpatient and outpatient). Collaborates with the multidisciplinary medical staff and establishes criteria for the safe, effective and… more
- Rochester Regional Health (Rochester, NY)
- …- 4:30PMSUMMARY Participates and supports oversight of office processes of the Medical Management Department to maintain daily operations. Oversees the daily ... review process of the third party payors ensuring information...Party Payors are maintained. + Participates and supports the medical management department in the tracking, trending and reporting… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The (per diem) Utilization Review Specialist coordinates scheduling of all surgical/endoscopic hospital admissions, pre-admission testing and ... preadmission testing and operating room time. 7. Checks credentials system for physician 's delineation of privileges for equipment and/or procedures according to … more
- University of Rochester (Rochester, NY)
- …Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records, ... and provide feedback on evaluations for direct and indirect reports. + Review and evaluate proposed promotions or terminations as appropriate. + Participate and… more
- Arnot Health (Elmira, NY)
- …Bachelor's in nursing preferred. Must have proficient writing skills.Experience in Utilization Review and InterQual required. CARDIOPULMONARY RESUSCITATION (CPR) ... of auth/denial review decisions. 8. Maintains a working relationship with Physician Advisor regarding physician issues related to auths/denials. 9. Provide… more
- CVS Health (Albany, NY)
- …meal delivery, assists with securing DME, and helps to ensure timely physician follow-up. - Understands Payer/Plan benefits, policies, procedures, and can articulate ... who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current...timelines. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more
- Trinity Health (Schenectady, NY)
- …clinical assessment of the patient's condition, need for rehabilitation therapy and medical treatment to be provided in the Inpatient Rehabilitation Facility (IRF) ... members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources. + Screening of clients… more