- Trinity Health (Troy, 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
- Centene Corporation (New York, NY)
- …VPMA responsibility in absence of VPMA. + Provide medical leadership for all utilization management , pharmacy, case management , disease management , ... Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
- Mohawk Valley Health System (Utica, NY)
- …+ 8 years of clinical experience. Previous or current experience working in Quality Management / Utilization Management field. + 5 years of management ... Sr Director Quality Management & Regulatory Affairs - Full Time -...QUALITY IMPROVEMENT Job Summary The Senior Director of Quality Management Systems and Regulatory Affairs is responsible for establishing… more
- Evolent (Albany, NY)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use… more
- Mohawk Valley Health System (Utica, NY)
- …+ 3 years of clinical experience. + Strong computer skills. PREFERRED: + Case Management , Utilization Management and Quality Management experience ... Transitional Care RN - Case Management - Full Time - Days Department: CASE MANAGEMENT Job Summary The RN - Transitional Care Coordinator is responsible for… more
- Mohawk Valley Health System (Utica, NY)
- …range of medical/clinical knowledge. + Expertise in, or willing to learn utilization management , state/federal regulations, private payer contracts. + Dedication ... medical license. PREFERRED: + Certification preferred or eligibility for certification in utilization management via certifying boards within 1-2 years of… more
- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- …achieve goals for eligibility, referral and authorization, care coordination, and utilization management to ensure improved Veteran experience. Makes ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization… more
- WMCHealth (Valhalla, NY)
- …an important role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes. Responsibilities: + ... with a third party leveling and/or appeals agency preferred. Previous utilization management , case management or peer review documentation experience in… more
- Evolent (Albany, NY)
- …training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- Evolent (Albany, NY)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more