- 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 + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- S&P Global (New York, NY)
- **About the Role:** **Grade Level (for internal use):** 13 **Director - Review Officer, Corporates & Infrastructure - S&P Global Ratings** **The Team:** The ... expertise + Previous experience in analytical quality assurance, validation, or review functions within financial services + Demonstrated ability to influence… 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 ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Evolent (Albany, NY)
- …Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , Interventional Pain Management, you will be a key member of the utilization ... Reviewers. **What You Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the… more
- Evolent (Albany, NY)
- …for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact ... reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (eg, cardiac catheterizations, coronary… more
- City of New York (New York, NY)
- …(1) Admin Staff Analyst NM III to function as a(n) Executive Director, Financial Review & Claims Processing who will: - Manage, plan and develop the operational ... activities of DFRP, ICP and SNAP-CR Directors as they administer their specific program areas which are responsible for initiating adverse actions on cash assistance cases due to information obtained via computer matches, sanctioning individuals who fail to… more
- City of New York (New York, NY)
- …and knowledgeable experts. The DOC seeks to recruit a Director of Internal Audit Review unit. The selected candidate will be responsible but not limited to the ... following; -Directing and administering the auditing activities of an agency based on identified risk assessments; -Working with the Auditing division or other organizational unit with an auditing, accounting, or financial function, including execution of… more
- 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… 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