- Humana (Albany, NY)
- …put health first** The UM Administration Coordinator contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert ... Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review for ... review.) + Prompt, courteous, professional and error free in performing utilization management functions. + Available to answer inbound phone calls within… more
- CDPHP (Latham, NY)
- …is required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services… more
- Helio Health Inc. (Syracuse, NY)
- …Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management ... review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ourSyracuse… more
- Northwell Health (Staten Island, NY)
- …another level of care according to regulatory standards. * * Performs concurrent utilization management using Interqual criteria. * Conducts chart review for ... management and clinical pathways, variance analysis and trending, quality management / utilization review and home care/discharge planning, preferred. * Keeps… more
- Mount Sinai Health System (New York, NY)
- …: + Active RN license in the state of employment required + Certification in Case Management (CCM, ACM) or Utilization Management preferred. + 7+ years of ... experience in clinical acute clinical, utilization management , appeals management or related operations + 3+ years in a leadership or management role +… more
- Guthrie (Binghamton, NY)
- …recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
- Evolent (Albany, NY)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
- Trinity Health (Albany, NY)
- …Albany, NY** is looking for an experienced RN to work as a Registered Professional Utilization Management Nurse (UMRN) per diem. The team is willing to help ... **The selected candidate will** : + Be responsible for the utilization management , both concurrent and retroactive for inpatient and outpatient services in… more
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