- 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
- Molina Healthcare (Yonkers, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... be licensed for the state they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer candidates with a… more
- Humana (Albany, NY)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- Arrow Electronics (Melville, NY)
- …design, product and proof of concept demonstrations, solution consultation, architecture review , and enablement of Arrow partners. The SED possesses a background ... Solutions Lab as a key differentiator for Arrow. Drive utilization through technology demonstrations, POCs, and innovation tied to...to assist in closing a deal. **Work Arrangement:** Fully Remote : Must be able to travel to an Arrow… more
- Centene Corporation (New York, NY)
- …requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate ... related to the members healthcare eligibility and access. + Aids the utilization management team and maintains ongoing tracking and appropriate documentation on… more
- Datavant (Albany, NY)
- …use cases and volume + Drive adoption of modernized workflows include Global and Remote processing + Maintain high customer retention and satisfaction as a partner + ... benchmarking, goal setting, timely execution, and superior leadership. + Strong utilization of SalesForce to include monitoring and documenting member information. +… more
- Highmark Health (Albany, NY)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... and servicing quality dental networks in assigned territory in a remote and mobile work environment. Manage network contracts including negotiations, contract… more
- CVS Health (Albany, NY)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Intermountain Health (Albany, NY)
- …patients and/or patient's family, caregivers, and/or legal representatives socio-economic review and screening to support coordination of care. Plans interventions ... to Friday with varying hours from 6:30 to 5 Pm. This is a fully remote position with NO on call requirements.** Participates in huddles with primary care practices… more
- Amgen (New York, NY)
- …through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested ... Offer office education during the access process, including formulary coverage/ utilization management criteria, insurance forms & procedures, benefits investigation,… more