- New York State Civil Service (Albany, NY)
- …our system through innovation and change, and will serve as OPWDDs first utilization review team. The BSARR Licensed Psychologist (Clinical Quality Team Lead) will ... support documentation to inform evidence-based decisions.. Analyzing and interpreting service utilization trends and clinical data to inform and enhance policies,… more
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or… more
- Molina Healthcare (Buffalo, NY)
- …key medical management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages ... with contracting/ network to standardize contracts for quality and utilization . **Job Qualifications** **REQUIRED EDUCATION:** Bachelor's Degree in Healthcare,… more
- Molina Healthcare (Rochester, 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
- Humana (Albany, NY)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… 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
- WMCHealth (Valhalla, NY)
- …the results. + Maintains familiarity with the laws, regulations, and interpretation of utilization review and discharge planning. Remains up to date on changes in ... Five (5) years of clinical nursing experience, two (2) years of Utilization Management or Appeal Management related experience Training/License: Current NYS RN… more
- Catholic Health Services (West Islip, NY)
- …collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals, Managed Care and Revenue Cycle and Patient ... Hospital Conditions of Participation. + Implements care management programs, including utilization review, intake and discharge planning. + Evaluates patient care… more
- Catholic Health Services (Roslyn, NY)
- …compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... utilization and denials. + Serves as a resource to physicians, physician advisors, CM department, and hospital staff. + Collaborates with all disciplines and departments to optimize key clinical and financial outcomes. + Participates in committee work at… more
- Mohawk Valley Health System (Utica, NY)
- …responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision ... Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member care needs… more