- Stony Brook University (Stony Brook, NY)
- …regulations, and third party contracts, as well as the Hospital inventory management system , electronic medical record and departmental documentation programs. ... regulations, and third party contracts, as well as the Hospital inventory management system , electronic medical record and departmental documentation programs. +… more
- Humana (Albany, NY)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Molina Healthcare (Albany, NY)
- **Job Description** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... members, providers, pharmacists, pharmacies, and technicians to meet departmental and CMS standards. + Enforce HIPAA compliance standards and regulations while… more
- Guidehouse (New York, NY)
- …timeliness and appropriateness of patient care + Conducts admission reviews for Medicare , Medicaid beneficiaries, as well as private insurers and self-pay patients, ... all applicable regulations, policies and timelines + Adheres to CMS guidelines for utilization reviews as evidenced by utilization...- REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and InterQual guidelines +… more
- Arnot Health (Elmira, NY)
- …on interpretation of regulatory standards, including The Joint Commission and Centers for Medicare and Medicaid Services ( CMS ); ensures a constant state of ... responsibility for quality improvement and compliance for the Arnot Health System . ** 2. Directs all organizational continuous accreditation readiness activities. **… more
- Ellis Medicine (Schenectady, NY)
- SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for case management of assigned patients on a designated unit(s). This position works with the ... Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration with physicians and social workers for care… more
- Saratoga Hospital (Saratoga Springs, NY)
- …state, federal and accreditation requirements, including but not limited to the Centers for Medicare and Medicaid ( CMS ) and the Joint Commission (JC), DNV, OSHA, ... our community. As part of the Albany Med Health System , we combine advanced technology with a deeply personal...to identified trends. + Assists with overall regulatory program management and maintains current working knowledge of the Hospital's,… more
- CVS Health (Albany, NY)
- …vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... compliance with internal policies and procedures as well as regulatory guidance from CMS , OIG or other Regulatory body. **Required Qualifications** + Minimum of 1… more
- Intermountain Health (Albany, NY)
- …alignment with ICD-10-CM and Official Coding Guidelines as determined by Centers for Medicare and Medicaid Services ( CMS ), National Center for Health Statistics ... Services (DHHS), American Hospital Association (AHA) and American Health Information Management Association (AHIMA). This position provides advanced training to CDI… more
- The New Jewish Home (Bronx, NY)
- …staff as required. o Leads the quality assessment, quality program management and quality 2. Performance improvement strategies for TNJH in collaboration ... with senior leadership and service delivery management . o Works to advance, develop, implement and refine...with evidenced based best practices that are compliant with CMS and NYS DOH requirements. o Facilitates and supports… more