- 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
- Catholic Health Services (Melville, NY)
- …Minimum Qualifications: 1. Minimum Education/Training Required: Graduate of an accredited medical school. Completion of specialty residency (ie, Internal ... the monthly Physician Advisor meeting. Attends hospital Utilization Management ( UM ) committees. Supervises the Facility Physician Advisors. Observes Catholic Health… 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
- 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
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity ... to the department, either by data analysis or by internal or external referral sources. Applies case management criteria...Certification required + Broad understanding of multiple areas (ie UM and CM). At this level, incumbent is required… more
- Evolent (Albany, NY)
- …and financial scope within Evolent Specialty Services. Reporting to the Director , Clinical Informatics, this role is responsible for acquiring, synthesizing, and ... and maintain the definitive source of truth for specialty Utilization Management ( UM ) agreements. This important work is achieved through collaboration across the… 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