- 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
- Molina Healthcare (Albany, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with PEGA helpful. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
- Kaleida Health (Buffalo, NY)
- …tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development ... skills including Microsoft word, Microsoft excel with spreadsheet development and utilization , Microsoft outlook required. 8 years of experience in multi- hospital… more
- University of Rochester (Rochester, NY)
- …Identifies problems that include but are not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal ... and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management, Medicaid Enrollment & Outreach, patients, families, third-party payers,… 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
- Gateway Hudson Valley (Kingston, NY)
- …County. + Participate in county-wide care management trainings, case reviews, and utilization reviews. + Participate in treatment team meetings for the purpose of ... and presentations to key players regarding Care Management services and service utilization + Travel to clinics throughout Ulster County to meet with individuals,… more
- Hillside Family of Agencies (Rochester, NY)
- …effectively to meet agency and regulatory requirements. + Facilitate Agency Utilization Management meetings to ensure residential youth continue to be placed ... recommendations. + Collect, aggregate, and analyze data to identify unmet needs, utilization trends, and opportunities for improvement of existing services as well… 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
- Evolent (Albany, NY)
- …claims, membership data, and clinical outcomes to uncover cost drivers, utilization trends, and opportunities for integrated care solutions using SAS, SQL, ... years of analytics & reporting experience in healthcare, including medical economics, cost/ utilization analysis, and membership trend reporting. + 2+ years in a… more
- Ellis Medicine (Schenectady, NY)
- …CMS Conditions of Participation at the direction of the Case Manager. * Utilization Management Activities; Collaborates with Case Managers and other team members for ... optimal Utilization Management information throughout the continuum. Maintains relationships with payers and communicates confidential information per policy.… more