- CenterWell (Albany, NY)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent ... community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a related field +… more
- Catholic Health Services (Smithtown, NY)
- …for patients across the acute care continuum. Performs required activities for utilization management , PRI assessment and completion, transition planning, and ... relevant clinical medical/surgical or specialty experience required. 2-3 years' Utilization Management , Performance Improvement, Transition Planning and/or Care… more
- Evolent (Albany, NY)
- …billing and various sites of care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical ... member-centric products. This role plays a critical part in both **Medical Cost Management ** and **Product Management ** , leveraging advanced analytics to solve… more
- Crouse Hospital (Syracuse, NY)
- …of hospital resources while maintaining the quality of care. + Participates in the utilization management process using standards of care to determine the most ... (5) years acute hospital experience. + NICU experience + Case Management or Utilization Management experience preferred. Benefits Overview: + Medical,… more
- Evolent (Albany, NY)
- …critical role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** + Process… more
- Molina Healthcare (Yonkers, NY)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… more
- Intermountain Health (Albany, NY)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Evolent (Albany, NY)
- …design and implement intuitive, efficient, and engaging user interfaces for our Utilization Management health care workflow applications. User research and ... with health care software development methodologies and lifecycles + Experience with utilization management and/or prior authorization processes is preferred +… more
- CDPHP (Albany, NY)
- …The pharmacy tech will participate in an on-call/holiday rotation along with a utilization management pharmacist to support Plan members in after hour pharmacy ... understanding of prescription and medical benefits as it applies to the utilization review process. + Must demonstrate proficient experience with the Microsoft… more
- Molina Healthcare (Yonkers, NY)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal… more