• Behavioral Health UR Clinician

    Independent Health (Buffalo, NY)
    … medical necessity decision; and preparing request for review by assigned medical director , as needed. + Perform utilization of behavioral health (BH) ... and accreditation entities. + Refer appropriate cases to the Medical Director for review and work closely...annual program evaluations and Work Plans for the BH UM and/or CM Programs. + Aid department efforts with… more
    Independent Health (05/15/25)
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  • Physician Advisor

    WMCHealth (Valhalla, NY)
    …and problems. + Participates in daily review of aggregate denials/appeals with the Medical Director , peer, or the Clinical Review Supervisor. + Provides ... is responsible for developing positive relationships with both employed and affiliated medical staff members in order to fulfill strategic business growth and… more
    WMCHealth (05/22/25)
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  • SN Community Health Assessment Field Nurse

    Excellus BlueCross BlueShield (Rochester, NY)
    …all 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
    Excellus BlueCross BlueShield (05/21/25)
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  • Case Manager, RN or Licensed Behavioral Health…

    Excellus BlueCross BlueShield (Rochester, NY)
    …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... + Case Management Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required to know multiple functional… more
    Excellus BlueCross BlueShield (05/22/25)
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