- 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
- 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
- Molina Healthcare (NY)
- …and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard ... medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) + Strong Knowledge of… 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
- WMCHealth (Kingston, NY)
- …that performs a functional evaluation of the client; conducts the planning and utilization of a program of purposeful activities; implements the development and ... utilization of a treatment program, and/or consultation with the...be rendered on the prescription or referral of a physician , nurse practitioner or other health care provider acting… more
- Fallon Health (Buffalo, NY)
- …Weinberg PACE. Work is performed under the general supervision of the Clinical Physician and Center Manager. The employee also interacts with and takes direction, at ... non-compliance.* + Provides nutrition education to participants/caregivers as ordered by physician and according to ADA* + Develops and maintains department policies… more