- CenterWell (Hauppauge, 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
- 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
- Molina Healthcare (Yonkers, NY)
- …and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports ... medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft… more
- Kaleida Health (Buffalo, NY)
- …tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development ... facilitating strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments and… more
- Abbott (Hauppauge, NY)
- …on clinical differentiation in the procedure, value proposition, product launch, physician onboarding, early case coverage and training. + Secondary responsibility ... This includes influencing stakeholders within the hospital, driving product utilization , support on contracting, relationship development, relationship management, market… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …management rounds. + Provision of clinical oversight and leadership to Utilization Management/Case Management (UM/CM) staff working with the children's population. + ... Develops and implements the BH sections of the Quality Management/ Utilization Management (QM/UM) Plan, including having the BH Medical...+ Must hold a NYS medical license as a physician board certified in child and adolescent psychiatry without… more
- New York State Civil Service (Albany, NY)
- …focus on prioritization and areas to be addressed through collaborative review and utilization of available data.* Serve as physician advisor to OPWDD Medical ... across the Division's nine Bureaus in need of the expertise of a physician including working with the Bureau Directors, the Division's Deputy Directors, the… more
- Catholic Health (Buffalo, NY)
- …guidelines, encourage patient self-management, increase coordination of care, increase the utilization of resources and services across the continuum and improve ... as a registered nurse required + One year previous case, disease, or utilization management experience preferred + One year previous experience in a physician… more