- Bassett Healthcare (Cobleskill, NY)
- …no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. Analyzes assessment data to ... no more than 2-3 exceptions, as measured by random supervisory chart review and/or direct supervisory observation. Identifies expected outcomes individualized to the… more
- WMCHealth (Valhalla, NY)
- …continuous education to physicians as needed on payor policies and workflows. + Utilizes medical review guidelines and parameters to assure consistency in the ... management areas of Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. + Reviews cases… 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 ... and community standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those cases in accordance… more
- Bassett Healthcare (Cooperstown, NY)
- …a principle liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate ... any urgent needs to IP CM/SW Utilization Review : Complete admission review for medical...Hazards: Occasional bodily fluids/bloodborne exposure Working Conditions: Occasional noise Travel : No travel required Total Rewards Bassett… more
- Fresenius Medical Center (Yonkers, NY)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Humana (Albany, NY)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health ... The Corporate Medical Director (CMD) relies on medical background to review health claims and...10-hour workdays per week, either Friday-Monday or Thursday-Sunday schedule. Travel : While this is a remote position, occasional … more
- Fresenius Medical Center (Jamaica, NY)
- …communicated to and implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records. + Complies with ... renal team. Communicates changes in patient status regarding clinical, insurance, travel and transportation issues to the disease management company. Maintains… more
- Merck (Albany, NY)
- …Trial Planning, Communication, Decision Making, Empathy, Market Access, Medical Affairs, Medical Research, Medical Review , Medical Writing, Patient ... **Job Description** **Role Summary:** The Sr. Global Director Medical Affairs (GDMA) is responsible for supporting the execution of scientific & medical affairs… more
- Guthrie (Corning, NY)
- …and autonomy in nursing practice. Preferred experience with PCMH process, care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... serve as a practice support in the Patient Centered Medical Home development and process. The position is an...disease management and high‐risk patient management. Other Duties: + Travel for this position may be required. + The… more
- Highmark Health (Albany, NY)
- …The Senior Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal ... insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes… more
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