- Healthfirst (NY)
- …+ BA or BSN + Relevant clinical experience such as previous care or utilization management , home care, or geriatrics + Knowledge of Department of Health ... and consistency. + Coordinates and communicates with Healthfirst Care Management teams regarding clinical eligibility issues, necessary service changes, and… more
- Albany Medical Center (Albany, NY)
- …and evaluation of services to patients and families + Collaborate with Risk Management , Patient Relations, Utilization Management , and Quality Management ... Department/Unit: Care Management /Social Work Work Shift: Day (United States of America) Salary Range: $65,102.17 - $100,908.37 Create optimal outcomes for the… more
- Robert Half Finance & Accounting (Lackawanna, NY)
- …contracts * Monitor key performance indicators (KPIs), including census/unit utilization , denial management , days in accounts receivable, benchmark/trends, ... rate methodologies, healthcare, mental health and dental billing * Analyze census/unit utilization to ensure programs properly maximize revenue * Oversee and manage… more
- Elevance Health (Latham, NY)
- …**Carelon Medical Benefits Management ** **Post Acute Care Benefit Utilization Management ** **Schedule: 10:00-7:00 Central Time** **** **Virtual:** This ... Operations Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and… 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 ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- MTA (Brooklyn, NY)
- …acquires a solid foundation, knowledge, and/or experience in the areas of utilization management , quality improvement, and employee fitness for duty ... control reviews. This includes but is not limited to fast-track case management , expansion on mobile medical assessments and projects which will improve return… more
- Molina Healthcare (Buffalo, NY)
- …strategy. **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and direction to Centralized Pharmacy Utilization Management team + Acts as liaison to internal ... + Develops policies and procedures as needed. + Participates in Quality Management and Health Education programs including, but not limited to, NCQA Accreditation,… more
- University of Rochester (Rochester, NY)
- …to integrate operations with other components of URMC, such as Financial Case Management , RIM, Utilization Management , Social Work, Patient Accounts, Medical ... Records, Finance, and Legal. + Serves as a liaison to patients, physicians, nursing, social workers, other URMC staff, insurance companies. Serves on committees/teams as designated. + Responsible for reviewing, validating, and maintaining accurate departmental… more
- Actalent (New York, NY)
- …(No time off during training) Overview Join a remote team conducting utilization management reviews (eg, prior authorizations, coverage exceptions). Work ... skills + Self-motivated and results-driven Preferred Skills + PBM or Case/Care Management experience + Retail pharmacy background preferred + Proficient in Word,… more
- Amgen (New York, NY)
- …+ Offer office education during the access process, including formulary coverage/ utilization management criteria, insurance forms & procedures, benefits ... Strong written and oral communication skills + Organizational skills and project management experience, including the ability to manage multiple projects + Strong… more