- Stony Brook University (Stony Brook, NY)
- …including managing Case Management leadership and staff functions related to case management and utilization management activities. + Manage and mentor a ... Coordinate the design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead initiatives to… more
- Arnot Health (Elmira, NY)
- … of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's average caseload ... Three years clinical nursing in acute care hospital setting or two years utilization management in an acute care hospital setting. Case management experience… more
- Molina Healthcare (Syracuse, NY)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- Evolent (Albany, NY)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Crouse Hospital (Syracuse, NY)
- …day management of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing ... Manager who is responsible for providing day to day management of the RN Care Managers in the department....acute care discharge planning + Preferred - Acute care utilization review experience Benefits Overview: + Medical, Dental, Vision,… more
- Northwell Health (New York, NY)
- …or throughout the entire continuum of health care delivery. Performs resource management , utilization management , discharge planning, care facilitation, ... duties with a defined patient population, and as it relates to care management and the delivery of patient care services. Communicates with payers addresses and… 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
- Molina Healthcare (Albany, NY)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member care management , and ... State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and evidence-based… more
- Centene Corporation (New York, NY)
- …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more