- Molina Healthcare (Yonkers, NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Humana (Albany, NY)
- …Registered Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) ... of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing… 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
- Anywhere Real Estate (Rochester, NY)
- …policy/program; delivering expatriate compensation-related services, counselling on best utilization of resources (ie language and cross-cultural trainings); ... by client policy + Counsel employees to the best utilization of program benefits + Demonstrate sound knowledge of...all pertinent records and ad hoc reports for management review and decision making + Maintain and Manage relationships… more
- Chinook Systems (NY)
- …Equipment (GFE)-provided platforms. Further, you will track labor and material utilization and prepare compliance-ready reports for Government visibility. As the ... standards. THIS POSITION IS CONTINGENT UPON CONTRACT AWARD. This position is REMOTE with 10% Travel, primarily site visits with our customer in Cornwall-On-Hudson,… more
- Merck (Albany, NY)
- …(ie patient support, education, risk management) as needed for appropriate and safe utilization of company medicines. + Partner with GSVC, CSEE, US Global Clinical ... Areas of Interest consultation, dissemination, data highlights, training, and scientific review as requested by the GMSA ED. **Required Qualifications, Skills &… more
- Highmark Health (Albany, NY)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Mount Sinai Health System (New York, NY)
- …of 340B program compliance, hospital pharmacy operations, and medication utilization . + Demonstrated ability to manage complex projects, prioritize tasks, ... interactive dashboards and reporting tools to monitor pharmacy expense trends, utilization , and key performance indicators. + Manage and maintain Pharmacy DataMart… more