- CenterWell (Liverpool, NY)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Humana (Albany, NY)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post… more
- Spectrum Health and Human Services (Buffalo, NY)
- …Care Coordinator will be responsible for the following outcomes: to reduce utilization associated with avoidable and preventable inpatient stays, to reduce ... utilization associated with avoidable emergency room visits, to improve...and improved health outcomes. + Consult with primary care physician and/or any specialists involved in the treatment plan.… more
- University of Rochester (Rochester, NY)
- …Identifies problems that include but are not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal ... and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management, Medicaid Enrollment & Outreach, patients, families, third-party payers,… more
- Humana (Albany, NY)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or… more
- SUNY Upstate Medical University (Syracuse, NY)
- …reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the appropriate ... required for interface and collaboration with leadership, colleagues, providers, Physician Advisors, regulatory agencies, and other health care-related entities are… more
- Highmark Health (Albany, NY)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... nature for profiling providers, assessing patient outcomes, studying cost and utilization trends and quantitative projections of industry and competitor performance,… more
- Mount Sinai Health System (New York, NY)
- …The Clinical Program Manager, Clinical Command Center is a Registered Professional Nurse, Physician Assistant, or Nurse Practitioner, who manages the 24 hour a day ... patient-centered care. **Qualifications** Must be a Licensed Registered Nurse, Physician Assistant or Nurse Practitioner Registered Nurse Bachelor?s Degree in… more
- Northwell Health (Melville, NY)
- …and knowledge gaps. Job Responsibility Serves as liaison between the patient and facility/ physician and the third party payer. Prepares and defends level of care and ... medical necessity for assigned case. Collaborates with physician advisor, payor representative and site case managers to facilitate appropriate level of care… more
- Rochester Regional Health (Rochester, NY)
- …the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members + Manages and coordinates patient care, ... + Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. + Attends… more
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