- Elderwood (Lake Placid, NY)
- …compliance with Federal, State, and facility policies + Actively participate in utilization management processes, including PDPM and state case mix systems ... + Conduct resident interviews + Compile, monitor, and audit clinical documentation + Communicate clinical issues effectively to appropriate clinicians + Support and assist the MDS/PPS Coordinator as needed + Demonstrate thorough knowledge of policies and… more
- Sodus Rehab & Nursing Center (Utica, NY)
- …concurrent review package. + . Submitting concurrent review package and follow up with Utilization Management team at the Managed Care Plan for status. + . ... Submit daily referral report. + . Submit on a weekly basis an outreach log of who/which external community partners/ hospitals were contacted for possible admissions. + . Admissions Coordinator must attend Outreach events on behalf of the Skilled Nursing Home… more
- 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. + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, PM&R, Anesthesiology and General Surgery clinical specialists **Work at Home Guidance** To… more
- Kaleida Health (Williamsville, NY)
- …with members of the interdisciplinary team to coordinate care, facilitate utilization and resource management and discharge planning functions, working ... 2 years of experience in any combination of case management , home care and utilization review preferred. Knowledge of and experience with Interqual Criteria… more
- City of New York (New York, NY)
- …analyze organizational structures, operational and accounting systems, procedures, programs, utilization of management information systems, machines and ... Move Outs of the agency. - Prepare and conduct management studies and surveys or administrative, procedural and operational...equipment, forms, and records management systems. - Prepare comprehensive reports of findings with… more
- Centene Corporation (New York, NY)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families… more
- Elevance Health (Latham, NY)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Nurse Case Manager II** will be responsible for care management within the scope of licensure for members with...individual and family needs, and develops a specific care management plan to address the objectives and goals identified… more
- Warner Bros. Discovery (New York, NY)
- …Proficient in SQL and visualization tools (such as Tableau, Looker) + Hands-on utilization of data management & modeling tools: DBT (preferred), AirFlow, ... throughout the data collection lifecycle, and developing shared documentation for proper utilization to support the overall execution of our data strategy. + Create… more
- Boehringer Ingelheim (Great Neck, NY)
- …along with further development of technical product knowledge is imperative. Effective utilization and management of internal and external resources is expected. ... records concerning activities; communicates timely, accurately and meaningfully with Management . Utilizes CRM tool and supporting analysis to plan activity,… more
- Sedgwick (Albany, NY)
- …:: To ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business lines ... on site at client locations; to provide expertise in client specific case management and utilization review requirements; and to ensure customer satisfaction… more