- Evolent (Albany, NY)
- …operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our behavioral health reviewers: ... Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. **What You Will Be Doing:** + Reviewing… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on...and medical criteria. + Assists with training medical director colleagues and nursing staff ,… more
- Molina Healthcare (Albany, NY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Catholic Health Services (Melville, NY)
- …the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician Advisors. Observes Catholic Health ... Qualifications: 1. Minimum Education/Training Required: Graduate of an accredited medical school. Completion of specialty residency (ie, Internal Medicine, Emergency… more
- BronxCare Health System (Bronx, NY)
- …activities and monitoring on a quarterly basis and reports findings/analysis to Director . - Conducts educational/feedback sessions with UM staff related to ... - Reviews and denials notification letters along with the medical records and all pertinent documentation related to the...response for submission in appeal. - In absence of Director , will review denial correspondence to determine validity of… more
- Kelly Services (Rochester, NY)
- …exception, and medical necessity reviews + Route cases to pharmacist/ medical director for final determination, as directed + Issue verbal ... processing and review of prior authorization requests for both pharmacy and medical specialty drug reviews as permitted by law. Reviews are conducted in… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …external standards set by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... refers potential quality of care and utilization issues to Medical Director . + Utilizes appropriate communication techniques...5 years. + Broad understanding of multiple areas (ie UM and CM). Incumbent is required to know multiple… more
- Ellis Medicine (Schenectady, NY)
- …discharge condition and final discharge plans. + Assists with ordering durable medical equipment. + Meets with patient, family and/or designee to ensure post-acute ... continuity of care and decrease length of stay + Appropriately refer and elevate medical and/or complex needs to appropriate case management and social work staff to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …mandatory trainings as required. + May be required to attend Fair Hearings with Medical Director relating to specific cases. + Works independently, as well as ... Community Health Assessment (CHA) Tools to determine functional status, medical , behavioral, psychological, and community resource needs for coordinating,… more
- ULTRA ELECTRONICS OCEAN SYSTEMS INC. (Victor, NY)
- …front-end modules, and digital signal processing electronics. Reporting to the Director of Electrical Engineering, you would provide leadership that fosters ... project execution challenges + Ensure all staff and programs comply with UM US engineering processes, policies, and standards + Provide technical oversight and… more