- MVP Health Care (Schenectady, NY)
- …with children and/or adolescents, with at least 2 years being ASD related + Utilization or Case Management experience in a managed care organization is preferred + ... meet established deadlines. + Ability to make independent decisions regarding resource utilization , and quality of care. + Must demonstrate understanding of clinical… more
- Centene Corporation (New York, NY)
- …+ Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to ... Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed… more
- Sharecare (Albany, NY)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, dental, and ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex pharmacy inquiries + Complex spending… more
- Sysco (Clifton Park, NY)
- …days and shifts as needed. + Oversee the proper selection, purchase, and utilization of company assets in support of the Delivery department. + Coordinate required ... and assist with the implementation of delivery changes. + Monitor the utilization of delivery services by reviewing the coordination of backhaul functions and… more
- Mount Sinai Health System (New York, NY)
- …credentialed designee. + Ability to interpret and apply principles of nursing research utilization . + Ability to manage and coordinate a patient caseload. + Work ... credentialed designee. + Ability to interpret and apply principles of nursing research utilization . + Ability to manage and coordinate a patient caseload. + Work… more
- Highmark Health (Albany, NY)
- …**JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most ... URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team… more
- Albany Medical Center (Albany, NY)
- …Use aggregate laboratory data to identify areas for improving laboratory test utilization . Ensure compliance with the laboratory and center compliance plans. Educate ... staff in daily operations. Develop and utilize management reports (workload, utilization , etc.) Establish departmental controls that support and guide the mission… more
- Molina Healthcare (Yonkers, NY)
- …and data management. * Advanced understanding health care operations ( utilization management, disease management, HEDIS quality measures, claims processing, etc.) ... Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. * Advanced problem-solving skills. *… more
- Molina Healthcare (Albany, NY)
- …cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm PST. This ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At least 2… more
- City of New York (New York, NY)
- …- Develop key performance indicators and systems to improve space utilization , assess needs, reduce costs, streamline processes, and improve efficiency and ... office services to promote and positive planning and report/track space utilization and seating assignments. - Create reports. Presentations, and summarize complex… more