- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... state of New York.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Humana (Albany, NY)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs basic administrative,… more
- University of Rochester (Rochester, NY)
- … remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent acute hospital ... Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: Range: UR URCB 213 Compensation Range: $69,326.00 -… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Molina Healthcare (NY)
- …Molina Healthcare is hiring for several Pharmacy Technicians. These roles are 100% Remote and require you be licensed either State or Nationally. These positions ... those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such… more
- Merck (Albany, NY)
- …support, educational or risk management) to support appropriate and safe utilization of Our Company medicines or vaccines. **Required Qualifications, Skills & ... days may vary by site or organization, with Friday designated as a remote -working day, unless business critical tasks require an on-site presence.This Hybrid work… more