- 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
- MVP Health Care (Tarrytown, NY)
- …of clinical nursing experience + At least 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines and ... every interaction **Your key responsibilities:** + Conduct timely and accurate utilization reviews for sub-acute Medicare cases. + Evaluate medical necessity, level… more
- CenterWell (Westbury, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more
- Molina Healthcare (Yonkers, NY)
- …care. Essential Job Duties * Performs audits of non-clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for ... Qualifications * At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of… more
- Evolent (Albany, NY)
- …Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical record… more
- Nuvance Health (Poughkeepsie, NY)
- …from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned ... and collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement. Utilizes criteria to confirm… more
- New York State Civil Service (Albany, NY)
- …with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) will have ... direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of child-serving… more
- New York State Civil Service (Albany, NY)
- …with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) will have ... direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of child-serving… more
- New York State Civil Service (Albany, NY)
- …with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) will have ... direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of child-serving… more
- Outreach Development Corporation (Brentwood, NY)
- …as directed by the Site Director. . Implement vocational services and promote utilization of staff that serves to enhance program utilization , service delivery ... . Initiate specialized projects, eg, outreach, to promote access and utilization of vocational services. . Provide support and direction to vocational/educational… more
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