- Northwell Health (Staten Island, NY)
- …+ Facilitates patient management throughout hospitalization + Performs concurrent utilization management using evidence based medical necessity criteria + ... Submits data to management regarding case management and/or quality initiatives + Serves as an in-patient liaison - planning, assessing, implementing and… more
- Molina Healthcare (Ramapo, NY)
- …example, such meetings would occur to discuss and resolve issues related to utilization management , pharmacy, quality of care, and correct coding. * ... and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability… more
- Molina Healthcare (Yonkers, NY)
- …with NCQA file review standards and surveyor interactions. + Experience with conducting Utilization Management and Population Health Management file audits, ... system analysis and program staff. These positions' primary focus is project/program management . **Job Duties** **Program Oversight & Project Management ** +… more
- Catholic Health (Buffalo, NY)
- …(the payers) and internal stakeholders including, but not limited to, Utilization Review, Case Management , Clinical Documentation Integrity, Health Information ... (CPMA), Certified Case Manager (CCM) or any other certification approved by management + Certification in a Nationally Recognized Utilization Review Criteria… more
- CVS Health (NY)
- …+ 3+ years of experience in a managed care clinical operation environment ( utilization management , case management , and/or behavioral health case ... Educator will support the training and compliance monitoring of the DSNP/MMP Management team. They are responsible for conducting audits of current processes,… more
- Veterans Affairs, Veterans Health Administration (Syracuse, NY)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Follows… more
- Catholic Health Services (Melville, NY)
- …initiated within 24 hours of admission / arrival. + Coordinate with onsite Case Management and Utilization Management to guarantee payer requirements are met ... Utilize work queues/work drivers and reports as assigned by management , to complete daily tasks. + Confirm that a...of FCC in-scope services. + Foresee and communicate to management team any significant issues/risks. + Propose innovative ideas… more
- Samaritan Daytop Village (Queens, NY)
- …program employees and agency administration. The Program Director will be responsible for census/ utilization management and quality assurance. What You Will Do + ... Role The Program Director is responsible for the overall clinical and budget management and administrative operations of his/her assigned program(s). He or she is… more
- Molina Healthcare (Buffalo, NY)
- …MI_** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental ... substance use services and assists with implementing integrated Behavioral Health care management programs. **Job Duties** * Serves as liaison between plan and… more
- University of Rochester (Rochester, NY)
- …such as Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient Accounts, ... Medical Records, Home Care Coordinators, Prior Authorization Teams, Contracting and Finance. + Coordinate with external entities including patients, families, physician offices, third party payers, Department of Social Services, Department of Health, police… more
Recent Jobs
-
Penske - Truck Driver - Local Class A - Penske Logistics
- Penske Truck Leasing (Novi, MI)
-
Academic Endocrinologist
- Health eCareers (San Antonio, TX)
-
Director, Engineering, Logistics & Distribution Technology
- Merck & Co. (Rahway, NJ)
-
Scientist Senior Associate
- Aequor (Thousand Oaks, CA)