- Centers Plan for Healthy Living (Staten Island, NY)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in… more
- NY CREATES (Albany, NY)
- …SUMMARY The Manager of Device Integration will be responsible for engineering and management of the NY CREATES Integration and Device Engineering group in support of ... business opportunities with existing and new customers, IP creation and management , and professional development of the Integration and Device Engineering Team.… more
- Molina Healthcare (Yonkers, NY)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members,...CMS standards. + Provides coordination and processing of pharmacy prior authorization requests and/or appeals. + Explains… more
- Molina Healthcare (Albany, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Bayer (Albany, NY)
- …experience, State Medicaid, and Managed Plans; + Experience in educating and supporting Prior Authorization process, appeals, and denials; + Covermymeds - portal ... experience; + In depth understanding of Payer/PBM therapy approval requirements ( Prior Authorization , Medical Necessity, Denial Appeals, Formulary coverage and… more
- New York State Civil Service (Menands, NY)
- …Registered Nurse 2 will be responsible conducting medical necessity reviews of prior authorization requests for treatment.Specific duties include, but are not ... limited to:* Conduct medical necessity reviews of all prior authorization requests (PARs) for treatment/procedures and/or testing to determine the medical… more
- Stony Brook University (Stony Brook, NY)
- …post-discharge and assist with barriers to care * Prior experience with Care Management or Utilization Management * Understand levels of care including ... quality multidisciplinary care is provided to the patients. * Documents the case management plans such as clinical needs, barriers, utilization of resources via… more
- Catholic Health Services (Roslyn, NY)
- …storage, inventory control, distribution, orders, prescriptions, and dispensing, insurance processing, prior authorization or other duties as required Assists ... skills and the capacity to work with patients, physicians, pharmacists, case management , and retail personnel with genuine care and empathy. Coordinate the filling,… more
- Catholic Health Services (Rockville Centre, NY)
- …storage, inventory control, distribution, orders, prescriptions, and dispensing, insurance processing, prior authorization or other duties as required Assists ... skills and the capacity to work with patients, physicians, pharmacists, case management , and retail personnel with genuine care and empathy. Coordinate the filling,… more
- University of Rochester (Rochester, NY)
- …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
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