- Highmark Health (Albany, NY)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Baylor Scott & White Health (Albany, NY)
- …patterns to key stakeholders. This will include close partnership with the BSWH utilization management function to gather information and resolve issues with ... BSWH overall business objectives. + Directs daily operations of clinical denial management , including the development and implementation of utilization policies,… more
- Molina Healthcare (Buffalo, NY)
- …retrieving specified information from data sources. + Knowledge of healthcare operations ( utilization management , disease management , HEDIS quality measures, ... and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard… more
- Molina Healthcare (Bronx, NY)
- …and cost-effective member care. Essential Job Duties * Performs audits in utilization management , care management , member assessment, behavioral health, ... 2 years health care experience, with at least 1 year experience in utilization management , care management , and/or managed care, or equivalent combination of… more
- Molina Healthcare (Buffalo, NY)
- …Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care ... management initiatives and analytical studies aimed at optimizing utilization of medical resources and maximizing operational efficiencies. + Engages with… more
- WMCHealth (Valhalla, NY)
- …Experience: Five (5) years of clinical nursing experience, two (2) years of Utilization Management or Appeal Management related experience Training/License: ... knowledge of nursing theory, nursing practice and practice standards for Utilization Management as related to Medicare, Medicaid and HMO's. Working knowledge… more
- Catholic Health Services (Roslyn, NY)
- …compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, ... Overview Director-Care Management Are you exceedingly driven, dedicated, and passionate...and appropriate documentation. Competencies + Priority Setting + Time Management + Action Oriented + Composure + Informing +… more
- Centene Corporation (New York, NY)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Nuvance Health (Poughkeepsie, NY)
- …case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within ... Nursing, BSN preferred. Must have current RN license. *Preferred Experience: * Utilization Review/ Management .Company: Vassar Brothers Medical Center Org Unit:… more
- Molina Healthcare (Buffalo, NY)
- …chief medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * ... as may be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/appeals. *… more
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