- Evolent (Albany, NY)
- …Doing:** As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... to evaluate all cases, which do not pass the authorization approval process at first call while promoting a...supported by Physician clinical review staff (MDs) in the utilization management determination process. Job Description +… more
- Highmark Health (Buffalo, NY)
- …member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate ... Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses… more
- Highmark Health (Albany, NY)
- … authorization . **ESSENTIAL RESPONSIBILITIES** + Obtain call task from Utilization Management platform, perform verbal outbound call task requirement ... **JOB SUMMARY** This job is responsible for completing all Prior Authorization outbound call tasks and/or inbound...result within the platform. + Obtain triage task from Utilization Management platform and follow a detailed… 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
- 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
- Evolent (Albany, NY)
- …working seamlessly with diverse teams and stakeholders + Deep understanding of prior authorization processes, reporting, and key performance indicators (eg, ... is preferred + Familiarity with value-based care models and utilization management frameworks is preferred To ensure...I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools… more
- Molina Healthcare (NY)
- …Job Duties * Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional ... requests. * Accurately enters approvals or denials of requests. * Facilitates prior authorization requests within established pharmacy policies and procedures. *… more
- Molina Healthcare (NY)
- …stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. * ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Molina Healthcare (Albany, NY)
- …stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. * ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- NBC Universal (New York, NY)
- …of our digital business is the ability for Account Directors and Sales Management to understand what ad inventory is available and when. The Inventory Execution ... Execution, you will be part of a team responsible for planning & yield management , forecasting & analyzing inventory and optimizing campaigns across a diverse set of… more