- Kaleida Health (Buffalo, NY)
- …Business field preferred. RN licensure required.** **Experience** **10 years of care management / utilization management experience required in hospital and/or ... **VP Care Management Post-Acute Care Transition** **Location:** **Buffalo General Medical...daily oversight of operations, the VP will partner with Utilization Review, Revenue Cycle, and Clinical leadership to create… more
- Molina Healthcare (Yonkers, NY)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Centene Corporation (New York, NY)
- …New York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- Humana (Albany, NY)
- …Professional plays a pivotal role in supporting Medicaid Inpatient and Outpatient Utilization Management (UM) forecasting and staff planning activities. This ... caring community and help us put health first** The Senior Workforce Management Professional applies and integrates advanced and predictive analysis, people metrics… more
- Elevance Health (Latham, NY)
- …providing services in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer skills. For ... experience and requires a minimum of 2 years clinical, utilization review, or case management experience; or any combination of education and experience, which… more
- Highmark Health (Albany, NY)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… 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
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + 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
- Trinity Health (Syracuse, NY)
- …Insurance Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization ... of possible concurrent denials, forwards information to the appropriate Utilization Management /Concurrent Review Nurse within identified process standards… more
Recent Jobs
-
Education Coach
- Starfish Family Services, Inc. (Livonia, MI)
-
Business Analytics Consultant Sr
- PNC (Washington, DC)
-
Senior Sales Executive - Mechanical Service
- Siemens (Cleveland, OH)
-
Full Stack Developer
- HighPoint (Washington, DC)