- Molina Healthcare (Yonkers, NY)
- …member care. Essential Job Duties * Performs audits of non-clinical staff in utilization management , care management , member assessment, and/or other teams ... * At least 2 years health care experience, preferably in utilization management , care management , and/or managed care, or equivalent combination… more
- New York State Civil Service (Albany, NY)
- …adolescents with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) ... will have direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of… more
- New York State Civil Service (Albany, NY)
- …adolescents with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) ... will have direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of… more
- Catholic Health Services (Melville, NY)
- …Physician Advisors during the monthly Physician Advisor meeting. + Attends hospital Utilization Management (UM) committees. + Supervises the Facility Physician ... + Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation. +… 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
- 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 ... Department/Unit: Care Management /Social Work Work Shift: Per Diem (United States...including pre-admission, discharge, post-discharge, planning length of stay, and utilization of resources.* Utilizes own special body of knowledge… more
- Kaleida Health (Buffalo, NY)
- …and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the ... to promote effective clinical validation improvement and clinical denial management system-wide. Significant influence on system quality and financial outcomes.… more
- Evolent (Albany, NY)
- …health) + Previous experience in a medical economics related position within Utilization Management /Clinical Vendor Management functions + Knowledge of ... healthcare underwriting methodologies + Familiarity with value-based care and utilization management + Understanding of data systems and the critical thinking… more
- Evolent (Albany, NY)
- …Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- New York State Civil Service (Albany, NY)
- …adolescents with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) ... will have direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of… more
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