- Centene Corporation (New York, NY)
- …for the business unit. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs ... medical review activities pertaining to utilization review, quality assurance, and medical review of complex,...the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. +… more
- Centene Corporation (New York, NY)
- …in absence of VPMA. + Provide medical leadership for all utilization management, pharmacy, case management, disease management, cost containment, and medical ... improvement activities. + Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial,… more
- Ellis Medicine (Schenectady, NY)
- …appropriate Level of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional ... provided by the Case Manager include, but are not limited to, utilization review, case management, care transition, collaboration with physicians and social workers… more
- Mount Sinai Health System (New York, NY)
- …on reducing the length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice and may require ... Masters preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or… more
- Mount Sinai Health System (New York, NY)
- …on reducing the length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice and may require ... Requirements** + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager… more
- Evolent (Albany, NY)
- …requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business ... and management staff as well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical audits for quality and… more
- Mount Sinai Health System (New York, NY)
- …and treatments plans are not required to be countersigned by a physician . **PRINCIPLES DUTIES AND RESPONSIBILITIES** **CLINICAL PRACTICE** + Assesses the health ... plan of care in the patient's medical record. + Consults with physician according to established standards, policies, procedures, and protocols. + Demonstrates the… more
- Molina Healthcare (Albany, NY)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, ... I + Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review...of Medicine or Doctor of Osteopathic Medicine. + The Physician is not the subject of any pending professional… more
- Rochester Regional Health (Rochester, NY)
- …optimal patient outcomes in the expected time frame and with most efficient utilization of resources. Carries out activities related to utilization management, ... base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay reviews and assists with managing the length of… more