- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all ... determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and… 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
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical information ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review/Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures all compliance paperwork is ... completed in a timely manor for the Upstate/Syracuse City School District school-based mental health care program. This position helps ensure successful visits by DNV and OMH when they occur. Monitors and maintains performance improvement indicators on a… more
- Molina Healthcare (Syracuse, NY)
- …Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management activities ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Northwell Health (Staten Island, NY)
- …delays and resolves issues with appropriate departments. + Identifies appropriate utilization of Social Work Services and makes referrals when appropriate. + ... a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues. +...regarding patient's status with regard to length of stay, utilization of resources and discharge status. + * Provides… more
- Molina Healthcare (Albany, 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
- Trinity Health (Troy, NY)
- …Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization ... Interacts with internal and external providers to review and monitor members' utilization of health care services with the goal of maintaining high-quality… more
- Centene Corporation (New York, NY)
- …for the business unit. + 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
- 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