- The Career Sphere (New York, NY)
- …compliance with all regulation changes as they impact medical and utilization review practicesDocument all review information as instructedCommunicate report results ... to the appropriate supervisorAccess electronic health information, as assigned/granted Do I Qualify? Must hold a current medical licenseMust be board certified within their clinical specialty (as appropriate)Currently works a minimum of 20 hours per month… more
- The Career Sphere (New York, NY)
- …for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United ... States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to… more
- Catholic Health Services (Melville, NY)
- …UR 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
- Catholic Health Services (Melville, NY)
- …as a liaison between patient account services, physicians, care coordinators, Utilization and Appeals Managers, physician advisors and facility departments. ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Coordinator will perform activities to help… 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- Catholic Health Services (Melville, NY)
- …from payors for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as ... 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
- 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
- Northwell Health (Mount Kisco, NY)
- …such as arrivals, no-shows, cancellations, bumps, patient cycle time, exam room utilization , physician productivity, and appointment lag. + Upholds and ... **Req Number** 168236 Job Description Manages daily operations of multi- physician practice(s)/hospital services for a Department/Division or Service Line. Manages… 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
