- Humana (Albany, NY)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs basic ... service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- CVS Health (Albany, NY)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Guthrie (Binghamton, NY)
- …necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this ... Provides health care services regarding admissions, case management , discharge planning and utilization review. Responsibilites: Reviews admissions and service… more
- Molina Healthcare (Yonkers, NY)
- **Knowledge/Skills/Abilities** + Perform research and analysis of complex healthcare utilization and performance date, claims data, pharmacy data, and lab data ... regarding utilization and cost containment information. + Evaluate, write, and...cost containment information. + Evaluate, write, and present healthcare utilization and cost containment reports and makes recommendations based… more
- Centene Corporation (New York, NY)
- …and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CDPHP (Albany, 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
- Mount Sinai Health System (New York, NY)
- …Excel and Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...EOW** To maintain front end operations of the Case Management Department by monitoring all incoming correspondence and ensuring… 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 ... track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient,… more
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... remain current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound knowledge and skill in the use of… more
- WMCHealth (Valhalla, NY)
- …the implementation or investigation of the procedures specified in the Quality Management , Utilization Review and Discharge Planning Program at Westchester ... of which must have been in the area of utilization review, quality assurance, risk management or...area of utilization review, quality assurance, risk management or discharge planning. About Us: Westchester Medical Center… more