- Molina Healthcare (Yonkers, NY)
- …design solutions utilizing provider data such as the Provider Online Directory, Utilization Management , Customer Experience, Enrollment, and Claims Payment and ... requirements of customers as it pertains to contracting, network management and credentialing. + **Knowledge/Skills/Abilities** + Strategically plans, leads, and… more
- Albany Medical Center (Albany, NY)
- …works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to ... in an assigned service - required + Recent experience in case management , utilization management and/or discharge planning/home care in a high volume,… 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
- Evolent (Albany, NY)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… 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
- Northwell Health (New Hyde Park, NY)
- …for the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug therapy ... Experience in formulary management , P&T committee support, and/or utilization management (PA, ST, QL) criteria development + Experience with benefit design,… more
- Molina Healthcare (Syracuse, NY)
- …health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs ... - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Rochester Regional Health (Rochester, NY)
- …efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other ... 3 years acute hospital care experience not required. PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience preferred. + Bachelor's… more
- Trinity Health (Troy, NY)
- …of experience in acute settingPreferred requirements:1+ year of experience in case management or utilization managementCase Management certification (CCM) or ... looking for a position in RN (Registered Nurse) Case Management in a dynamic hospital, this could be your...guidelinesResponsibilities:Engage the patient and care team in the joint management of key patient outcomes such as management… more
- Molina Healthcare (NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
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