- Molina Healthcare (Rochester, NY)
- …experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred ... License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI WORK SCHEDULE: Mon… more
- City of New York (New York, NY)
- …Staff Analyst NM-I to function as a Deputy Director of Single-Issue Review , who will: Supervise three analytical staff that are responsible for submitting ... over $50 million in claims for federal and state reimbursement. Ensure all participant and invoice data for claims are analyzed, reviewed and compiled accurately. Responsible for ensuring the accurate and timely submissions of Homebase, Anti-Eviction and… more
- SMBC (New York, NY)
- …a competitive portfolio of benefits to its employees. **Role Description** SMBC Credit Review Department (CRVD) seeks a VP Senior Data Analytics Officer to join its ... Data Analytics Team in White Plains, Manhattan, or remotely. The incumbent will be a part of a dynamic team to support the reviews and continuous monitoring of retail portfolios through data analysis of the total population and present them through effective… more
- Molina Healthcare (Buffalo, NY)
- …experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred ... License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE** **Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI** **WORK… more
- Molina Healthcare (Syracuse, NY)
- …+ Provides telephone, clerical, and data entry support for the Care Review team. + Provides computer entries of authorization request/provider inquiries, such as ... eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes. + Responds to requests for… more
- MUFG (New York, NY)
- …portfolios to identify deterioration or negative management control trends and review compliance with policies, guidelines, and regulations. + Prepare periodic Risk ... Profile & Monitoring Plans to outline key risk factors and allocate appropriate resources. + Analyze individual credits and/or credit relationships for quality, adherence to approval conditions, the accuracy of risk grading, and adequacy and accuracy of… more
- M&T Bank (Amherst, NY)
- …+ Monitor work flow and serve as liaison between assigned Item Processing & Deposit Services unit and management. + Provide training and coaching to assigned Item ... Processing & Deposit Services team on daily work functions and approve work of assigned team. Assist with onboarding new hires. + Assist with production work on an as needed basis. + Complete daily production reporting for assigned Item Processing & Deposit… more
- Intermountain Health (Albany, NY)
- …Provides extraordinary care to our customers through friendly, courteous, and professional service through a broad understanding of account handling processes, ... extraordinary interpersonal skills, and the ability to resolve complex issues in a timely and accurate manner. **Essential Functions** + Identifies appropriate payment details and saves back-up as appropriate. + Researches, validates and makes adjustments to… more
- Molina Healthcare (Syracuse, NY)
- …ARIZONA RESIDENCY REQUIRED** This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN/and or a compact licensure. The ideal ... candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Remote… more
- Molina Healthcare (Syracuse, NY)
- …**Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an ... integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and… more