- Humana (Albany, NY)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance ... organizations, hospitals and other healthcare providers, patient interaction, etc. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office… more
- Monte Nido (Northport, NY)
- …and outpatient providers + Interact with insurance companies for pre-certification and utilization management + Participating in discharge and aftercare planning ... + Therapeutic meal support, while modeling a healthy relationship with food + Provides safe, empathetic, and affirming care for each client and their unique circumstance based on the clients' intersecting identities Qualifications: + Master's degree in… more
- Molina Healthcare (Rochester, NY)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay… more
- Monte Nido (Victor, NY)
- …and outpatient providers + Interact with insurance companies for pre-certification and utilization management + Participating in discharge and aftercare planning ... + Therapeutic meal support, while modeling a healthy relationship with food + Provides safe, empathetic, and affirming care for each client and their unique circumstance based on the clients' intersecting identities Qualifications: + Master's degree in… 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
- Norstella (Albany, NY)
- …or Specialty pharmacy. + Comprehensive knowledge of both pharmacy and medical benefit utilization management policies + Proven ability to exceed expectations and ... achieve goals + Excellent presentation and communication skills + Strong analytical and critical thinking skills + Strong organization skills with the ability to prioritize in a dynamic environment + Self-motivated with a strong "can do" attitude **Additional… more
- Elderwood (Liverpool, 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
- Monte Nido (White Plains, NY)
- …and outpatient providers + Interact with insurance companies for pre-certification and utilization management + Participating in discharge and aftercare planning ... + Therapeutic meal support, while modeling a healthy relationship with food + Provides safe, empathetic, and affirming care for each client and their unique circumstance based on the clients' intersecting identities Qualifications: + Master's degree in… more
- Evolent (Albany, NY)
- …care, HIPAA, provider and vendor contracting, compliance, population health (including utilization management ), Medicare, and Medicaid. + Draft, review and ... negotiate contracts with providers, vendors, managed care customers, and other third parties to ensure compliance with applicable statutes, case law, governmental regulations and Evolent policy guidelines. Analyze and advise business owners of contractual… 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