- Guidehouse (New York, NY)
- …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse ** Travel Required** **:** None **Clearance Required** **:** None...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
- CenterWell (Albany, NY)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Albany, NY)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Molina Healthcare (Buffalo, 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
- Agiliti Health (NY)
- **POSITION SUMMARY** Create and deliver high-impact, customer-facing business- review presentations that clearly communicate Agiliti's value, service performance, and ... contract utilization trends. This role blends visual storytelling expertise with...AND RESPONSIBILITIES** + Design and produce facility- and division-level business- review decks that highlight service performance, spend trends, and… more
- Molina Healthcare (Yonkers, 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
- 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
- Global Foundries (Malta, NY)
- …their markets. For more information, visit www.gf.com . Summary of Role: The travel , Card and expense coordinator will oversee the administrative support across all ... travel , card, and expense activities. This individual will be...card status, renewals, and credit limits + Run and review delinquency reports monthly and follow up on late… more
- Molina Healthcare (Rochester, NY)
- …stay for requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide ABA/BHT services to Molina ... by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not… more
- Molina Healthcare (Rochester, NY)
- …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested, may be required. This can… more