- Humana (Albany, NY)
- …or experience in operational areas subject to accreditation requirements (such as utilization management , case management , credentialing, network operations, ... audits. + Able to organize team documentation and archive. + Support management of large-scale NCQA governance committee by building newsletters and taking meeting… more
- Catholic Health (Buffalo, NY)
- …Health. This role also has secondary oversight for inpatient clinical denials, Utilization Management and vendor performance of Healthcare Solutions WNY as ... sections of the revenue cycle: + Patient Access + Health Information Management + Coding and Coding Education + Inpatient, Outpatient and Ambulatory Clinical… 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
- Molina Healthcare (Syracuse, NY)
- …and supervises a team supporting non-clinical healthcare services activities for care management , care review, utilization management , transitions of care, ... Molina's clinical/healthcare services function, which may include care review, care management , and/or correspondence processing, etc. * Researches and analyzes the… more
- CVS Health (Albany, NY)
- …+ 5-7 years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management (UM) and Case Management ... all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… 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
- Centene Corporation (New York, NY)
- …Nursing preferred. 3+ years of combined nursing and appeal and grievance, or utilization management or case management experience. Previous supervisory ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Healthfirst (NY)
- …+ **BA or BSN** + **Relevant clinical experience such as previous care or utilization management , home care, or geriatrics** + **Knowledge of Department of ... and consistency.** + **Coordinates and communicates with Healthfirst Care Management teams regarding clinical eligibility issues, necessary service changes, 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
- University of Rochester (Rochester, NY)
- …Medicare and other payer regulations for the coordination of benefits. + Notifies Utilization Management of clinical requests by third party payers. + Maintains ... considerations._ **Responsibilities:** GENERAL PURPOSE Manages and provides financial account management for all urgent, emergent, and pre-admission visits with a… more