- Centene Corporation (New York, NY)
- …taken on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve ... and concurrent review findings + Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members + Provides… more
- Molina Healthcare (Buffalo, NY)
- …medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies ... as may be required. * Serves as a clinical resource for utilization management, chief medical officer, physicians, and member/provider inquiries/appeals. * Provides… more
- Highmark Health (Albany, NY)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... nature for profiling providers, assessing patient outcomes, studying cost and utilization trends and quantitative projections of industry and competitor performance,… more
- Arc Allegany-Steuben (Bath, NY)
- …requires proficiency with EVero software to manage billing processes, track utilization , reconcile records, and ensure all billing is submitted to accounting ... unbilled services and ensure submission before monthly deadlines. + Provide monthly utilization and billing summary reports to program leadership and Accounting. +… more
- WMCHealth (Valhalla, NY)
- …of service, quality cost and access are maintained. . Manages the effective utilization of existing warehousing and inventory facilities across the network . Drives ... high utilization of standard processes and procedures to ensure maximum...forecasting to optimize purchasing planning with the warehouse and utilization planning with the Demand Planning and System Procurement… more
- CVS Health (Albany, NY)
- …urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior ... Multiple state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor… more
- Molina Healthcare (Albany, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2 ... or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. LVN /… more
- Guthrie (Binghamton, NY)
- …years of experience in an acute care setting with strong care management, utilization review, and payer knowledge. A Case Management certification or obtain a Case ... the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and other… more
- University of Buffalo - Campus, Dining (Buffalo, NY)
- …culinary staff in contract dining in the following areas: understanding and utilization of recipes, food handling procedures, kitchen safety and sanitation, cooking ... methods, product taste and presentation, use of equipment, leftover utilization and proper record keeping. . Hands on training and development of culinary employees.… more
- Catholic Health (Buffalo, NY)
- …medical record and claims data in order to track and trend health care utilization and quality of care for the population health business model. This responsibility ... will be used to monitor health care quality and utilization within the CMP network and to promote clinical...tool to create reports to meet our quality and utilization objectives and NCQA accreditation requirements. Additionally, the Healthcare… more
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