- Mount Sinai Health System (New York, NY)
- …resources, crisis intervention, patient/family counseling and psycho education, timely documentation, utilization management care plans/case management , and ... advocacy. **Qualifications** + Master's Degree in Social Work from an accredited School of Social Work. + LCSW required. + Five years post Masters experience in the social service and/or health care field, preferably in a medical setting. + Minimum of one… more
- Evolent (Albany, NY)
- …various sites of care/service is preferred + Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the ... will partner closely with executives across analytics, finance, product and account management . **What You Will Be Doing:** + Support Business Development & Product… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …with CDPAS documentation and authorizations. PRIMARY RESPONSIBILITIES: + Point person for Utilization Management , Case Management and G&A regarding ... resolution to members request for a change in provider + Communicate with current provider regarding stabilizing services + Communicate with providers regarding staffing new cases + Assist delegating CDPAS documentation to appropriate departments + Correspond… more
- CDPHP (Latham, NY)
- …two (2) years experience in a health insurance related discipline required. + Utilization management experience is preferred. + Knowledge of managed care, health ... CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services,… more
- Bowery Residents Committee (Manhattan, NY)
- …plans, and crisis intervention. Gather and review documentation as requested for utilization management reviews of clients on caseload including completion of ... MSW or CASAC-T License required. LMHC or LMSW preferred. Excellent time management skills. Bachelors strongly preferred. Knowledge of OASAS rules and regulations and… more
- Highland Hospital (Rochester, NY)
- …benefits, identifies and resolves coordination of benefits discrepancies, and notifies Utilization Management of additional clinical requests **Salary Range:** ... for out-of-network payers, refers our self-pay patients to Financial Case Management (FCM) for Medicaid assessment or Financial Assistance, reviews and validates… more
- PNC (New York, NY)
- …+ Manages various projects and analytics which may include creation, maintenance and utilization of management reports to help the group meet their goals ... Director, MBS Portfolio Manager within PNC's Asset & Liability Management organization, you will be based in New York...expertise: *Minimum 12 years of experience in fixed-income portfolio management , with a focus on agency MBS. *Expertise in… more
- Highmark Health (Albany, NY)
- …AI techniques, assessing their applicability to core healthcare payer operations (eg, utilization management , claims processing, member services). 3. Modeling & ... Experimentation: Conduct experiments in prompt engineering, model fine-tuning, and embedding generation to optimize LLM performance and minimize 'hallucination' for healthcare-specific data. 4. Cross-Functional Collaboration: Partner with data science,… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists… more
- Elderwood (Hamburg, NY)
- …Federal and State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix process. ... + Conducts resident interviews. + Compile, monitor and audit clinical documentation. + Communicate clinical issues to appropriate clinicians . + Supports and assists MDS/PPS Coordinator as directed. + Demonstrates knowledge and understanding of all policies… more
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