- Catholic Health Services (Melville, NY)
- …department, and presents to Physician Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management (UM) committees. ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the… more
- WMCHealth (Valhalla, NY)
- …business growth and objectives. This position plays an important role in ensuring physician support and execution of for Utilization Management and Documentation ... a resource for initial clinical reviewers. + Serves on UM Committee .Provides Physician administrative support and leadership to the utilization and resource… more
- Mohawk Valley Health System (Utica, NY)
- …hospitals objectives, and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides the team to ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job Summary The...correct level of care and reimbursement. Apply knowledge of utilization review, discharge planning, patient status changes, length of… more
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - Friday, ... as needed. Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial management as… more
- Highmark Health (Albany, NY)
- …Inc. **Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician... utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and… more
- Guidehouse (New York, NY)
- …appropriateness for inpatient level of care or observation services based on physician certification + Gathers clinical information to conduct continued stay ... utilization review activities with payers on a daily basis...of the relevant guidelines and appropriate referrals to the physician advisor and the UR Committee + Identifies, develops… more
- Guthrie (Binghamton, NY)
- …care services regarding admissions, case management, discharge planning and utilization review. Responsibilites: Reviews admissions and service requests within ... needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally… more
- CDPHP (Albany, NY)
- …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 ... you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical...a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- …goals for eligibility, referral and authorization, care coordination, and utilization management to ensure improved Veteran experience. Makes recommendations for ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization reports… more