- Northwell Health (Manhasset, NY)
- …+ Facilitates patient management throughout hospitalization. + Performs concurrent utilization management using evidence based medical necessity criteria. + ... Submits data to management regarding case management and/or quality initiatives....collaboration with the health care team. + Conducts chart review for appropriateness of admission and continued length of… more
- Highmark Health (Albany, NY)
- …regulatory requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, ... and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and...accurate and timely routing of service requests to the nurse reviewer to assure that the decision… more
- Fresenius Medical Center (Batavia, NY)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Nuvance Health (Carmel, NY)
- …in an acute care setting; Leadership experience preferred; Utilization review , discharge planning or case management experience preferred. Location: ... Carmel-PHC 670 Stoneleigh Avenue Work Type: Full-Time Standard Hours: 37.50 FTE: 1.000000 Work Schedule: Day 10 Work Shift: This is a Monday thru Friday position with rotating weekends. 8am-4pm Org Unit: 1168 Department: Care Coordination Exempt: Yes Grade:… more
- Molina Healthcare (Syracuse, NY)
- …or emergency room. Previous experience in ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. ... Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). LVN (Licensed Vocational Nurse ) or LPN… more
- Molina Healthcare (Rochester, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Molina Healthcare (Yonkers, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Centene Corporation (New York, NY)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Northwell Health (Staten Island, NY)
- …care according to regulatory standards. * * Performs concurrent utilization management using Interqual criteria. * Conducts chart review for appropriateness ... * Current license to practice as a Registered Professional Nurse in New York State. * Case Management... and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge… more
- Molina Healthcare (Rochester, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more