- Evolent (Albany, NY)
- …: Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power ... years of analytics & reporting experience in healthcare, including medical economics, cost/ utilization analysis, and membership trend reporting. + 2+ years of SQL… more
- CVS Health (Albany, NY)
- …o Consulting with and recommending standard and custom formulary options and utilization management edits. o Collaborating with internal partners to develop or ... rebate value and drives lowest net cost. o Consulting with and recommending utilization management programs or other clinical programs to a client. o Consulting with… more
- Rochester Regional Health (Rochester, NY)
- …optimal patient outcomes in the expected time frame and with most efficient utilization of resources. Carries out activities related to utilization management, ... base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay reviews and assists with managing the length of… more
- Ellis Medicine (Schenectady, NY)
- …provided by the Case Manager include, but are not limited to, utilization review, case management, care transition, collaboration with physicians and social workers ... experience in a hospital environment preferred. + Previous case management, utilization review, and discharge planning experience highly preferred. Home care, payer,… more
- Centene Corporation (Queens, NY)
- …Drive optimal performance in contract incentive performance, quality, and cost utilization . + Conducts regular in-person visits with physicians to provide real-time ... in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization , etc. + Completes special projects as assigned + Ability to travel… more
- Evolent (Albany, NY)
- …As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more
- SUNY Upstate Medical University (Syracuse, NY)
- …and community-based partners to develop strategies to decrease unnecessary hospital ED utilization . In this position, the social worker will Identify utilization ... knowledge of social determinants, population health and drivers of utilization . Duties will include consultation through assessment, counseling, intervention,… more
- Humana (Albany, NY)
- …supporting provider performance, and coordinating with cross-functional teams to drive quality, utilization , and cost-of-care outcomes. At the core, this is a role ... MRA, chronic condition management, and other efforts to reduce avoidable utilization * Supporting Joint Operating Committees (JOCs) and facilitating implementation… more
- Evolent (Albany, NY)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures.… more
- Molina Healthcare (Buffalo, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more