- 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
- 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
- American Express (New York, NY)
- …end-to-end data management tooling roadmap. + Drive the adoption and effective utilization of data management tools across various teams and functions. + ... processes. + Develop guidelines and documentation for the selection, deployment, and utilization of approved enterprise data management tools. + Collaborate with… more
- Evolent (Albany, NY)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… 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 ... or BSN preferred. Must have current RN license. Preferred experience in Utilization Review/ Management .Company: Vassar Brothers Medical Center Org Unit: 1190… 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
- 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
- Mount Sinai Health System (Long Island City, NY)
- …Description** The Director will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate ... nursing or healthcare-related field **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience… more
- Evolent (Albany, NY)
- …Description As a Clinical Reviewer, Physical Therapy you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews charts… more