- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services ... is required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is preferred. +… more
- Molina Healthcare (Buffalo, NY)
- …board licensing mandate. + At least 2 years in case, disease or utilization management; managed care; or medical/behavioral health settings. + One year of training ... Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional in Health Care… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
- Humana (Albany, NY)
- …into concrete roadmaps that will generate tangible value to all stakeholders. Within Utilization Management, our goal is to enable members to receive the most ... appropriate type of care as quickly as possible all while streamlining processes for our provider partners and reducing unnecessary costs from the healthcare system. Our team employs a rigorous process to set specific business priorities, identifies the… more
- Stony Brook University (Stony Brook, NY)
- …standards within the scope of Case Management including, outcomes management, utilization and appeal management, reporting/data analysis to leadership and staff. ... following but are not limited to:** + Responsible for addressing Utilization management, denials and appeal, discharge and transition planning activities, quality… more
- Centene Corporation (New York, NY)
- …York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + Actively ... for the business unit. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, ... Level I + Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include:… more
- Molina Healthcare (Rochester, NY)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- Molina Healthcare (Syracuse, NY)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs ... medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.… more