- 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
- Molina Healthcare (Yonkers, NY)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...providers when overpayments are identified. + Works may be remote , in office, and on-site travel within the state… more
- Cognizant (Albany, NY)
- …guidelines and regulations. * Experience in the analysis and processing of claims, utilization review /quality assurance procedures. * Must be able to work with ... flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified applicants in the United States. Regardless of… more
- Wolters Kluwer (Albany, NY)
- …opportunities in the named customer base, including: + Conducting regular account review meetings and reviewing account utilization management reporting to ... **_ This is a remote position covering the New England territory _**...communication **Travel Requirements** + 25-50% within territory \#LI - Remote _Applicants may be required to appear onsite at… more
- Optiv (New York, NY)
- _This position will be fully remote and can be hired anywhere in the continental US_ The Practice Manager is a key leadership role within our Services consulting ... documented, up to date, and consistently applied across all projects + Review and approve project deliverables for accuracy, completeness, and alignment with… more
- WMCHealth (Valhalla, NY)
- Senior Inpatient Coder ( REMOTE ) Company: NorthEast Provider Solutions Inc. City/State: Valhalla, NY Category: Clerical/Administrative Support Department: Health Info ... to the the coding leadership team. + Participates in mandated medical record review processes. + Using current ICD10 CM/PCS coding systems, assigns and records an… more
- Molina Healthcare (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
- Mount Sinai Health System (New York, NY)
- …consistently expanding through organization wide system development and departmental utilization of Stratajazz. + Responsible for development and implementation of ... developments in the fields of information technology. Write recommendations for management review of enhancements to existing systems through ongoing review . +… more
- Anywhere Real Estate (Buffalo, NY)
- …problems; + Work with the Engineering team to conduct design and peer code review ; + Acquire knowledge of existing systems and the underlying business processes they ... customers, analysts, data scientists, and operations teams which will increase the utilization of our products and achieve competitive advantage; + Remain abreast of… more