- Trinity Health (Syracuse, NY)
- …in terms of quality, safety, service, affordability, and technology. Oversees drug utilization management efforts; manages the pharmaceutical supply chain; and ... including new services/programs, revenue enhancement, expense reduction, managed care utilization systems, and strategies. Responsible for ensuring performance excellence… more
- Molina Healthcare (Albany, NY)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... proficient, self-directed, autonomous and experience working from home. Care Management & Waiver Service Auditing experience is highly preferred. Work… 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
- FLACRA (Penn Yan, NY)
- …progress notes and other documentation required for the client medical record and utilization management within the timelines outlined by FLACRA. + Participates ... + Monitors, support, and mentors clinicians in their practice management to meet expectations for excellent client care. +...in quality initiatives and utilization review activities as requested. + Strives to understand… more
- Centene Corporation (Queens, NY)
- …of managed care or medical group experience, provider relations, quality improvement, utilization management , or clinical operations. Project management ... care to our members. Participate in the development of network management strategies. Creates strategic initiatives for performance improvement. + Conducts regular… 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 ... Three (3) - Five (5) years acute hospital experience. + Case Management or Utilization Management experience preferred. Benefits Overview: + Medical, Dental,… more
- Highmark Health (Buffalo, NY)
- …the requested authorization. **ESSENTIAL RESPONSIBILITIES** + Obtain call task from Utilization Management platform, perform verbal outbound call task ... appropriately log result within the platform. + Obtain triage task from Utilization Management platform and follow a detailed desk level procedure to enter the… more
- Evolent (Albany, NY)
- …Oncology is a key clinical executive responsible for leading oncology-related utilization management , quality improvement, and clinical operations across ... cost of oncology care + Lead the development of strategies for care management , utilization mitigation, and value-based incentive programs **Desired Skill Set**… more
- CDPHP (Latham, 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
- Highmark Health (Albany, NY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more