- Boehringer Ingelheim (New York, NY)
- …and leads collaborative implementation when appropriate. May be involved in the utilization of advanced analytics and informational resources to monitor and engage ... risk associated with marketing programs and material by working within the HPRC review process. Meets performance and financial targets for the brand including net… more
- Molina Healthcare (NY)
- …requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework + Practice ... + Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare + Advanced knowledge of SQL + Proficient… more
- Sharecare (Albany, NY)
- …techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also ... in the orientation and to take the pre and post tests to review competency during orientation. Yearly competency tests are required for all Sharecare clinicians.… more
- Evolent (Albany, NY)
- …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Agiliti Health (NY)
- **POSITION SUMMARY** Create and deliver high-impact, customer-facing business- review presentations that clearly communicate Agiliti's value, service performance, and ... contract utilization trends. This role blends visual storytelling expertise with...support revenue retention and growth. This position is a remote opportunity and has flexibility to be based anywhere… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Perform medical review activities pertaining to utilization review , quality ... with respect to clinical issues and policies. + Identify 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
- Humana (Albany, NY)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- CenterWell (Hauppauge, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... **Branch Location** : Hauppauge, NY **This is not a remote or work-from-home position. This position requires you to...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more