- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of behavioral health (BH) services for members, ensuring compliance with ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- Centene Corporation (New York, NY)
- …have an active New York State RN license.** **Inpatient Utilization Management** **Position Purpose:** Supervises Prior Authorization, Concurrent Review, and/or ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York City Children's Center - Bronx Campus, P27076 Occupational ... New York City Children's Center - Bronx Campus is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency of… more
- CVS Health (Albany, NY)
- …opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with productivity and… more
- CVS Health (Albany, NY)
- …skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult inpatient behavioral ... appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for child and adolescent members. + Consults and… more
- Helio Health Inc. (Syracuse, NY)
- …review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ourSyracuse ... appropriate. + Assist in developing and administering policies and procedures for utilization . + Negotiating access to care for individuals seeking services at Helio… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert Packer ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for… more
- New York State Civil Service (New York, NY)
- NY HELP No Agency Empire State Development, NYS Title Project Manager, Utilization - MWBE Occupational Category Other Professional Careers Salary Grade NS Bargaining ... direct supervision of the Director of Contract Participation, the Project Manager, Utilization , will lead the planning, execution, and monitoring of key initiatives… more
- Humana (Albany, NY)
- …part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently… more
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