- 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
- CenterWell (Hauppauge, 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
- Northwell Health (New Hyde Park, NY)
- …Job Responsibility + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy, ... and Therapeutics Committee; monitors medication utilization effectively and intervenes when necessary to ensure compliance. + Monitors pharmacists activities… more
- City of New York (New York, NY)
- …(EOIP)unit was created to support the Mayor's goal of increasing the utilization of minority-owned and/ or women-owned business enterprises (M/WBEs) in the design ... regular audits and compliance reviews to verify adherence to M/WBE utilization plans in tax-incentivized housing developments. - Collaborate with internal and… more
- Evolent (Albany, NY)
- …As a Clinical Reviewer, Physical Therapy you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews charts… more
- Humana (Albany, NY)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- Abbott (New York, NY)
- …Additionally, this role is responsible for onsite marketing activities, clinic product utilization and ongoing product sales. **What You'll Work On** + Conduct phone ... calls, visits, and administrative support to increase growth, revenue, and utilization of eScreen products + Ensures clinics are providing outstanding service… more
- Highmark Health (Albany, NY)
- …including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making ... of their data analysis.This includes benefits design analysis based on benefit utilization while factoring in financial analysis to determine cost impact. +… more
- Sedgwick (Albany, NY)
- …ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines by managing and ... locations; to provide expertise in client specific case management and utilization review requirements; and to ensure customer satisfaction through the provision… more