- Hillside Family of Agencies (Rochester, NY)
- …of the day-to-day operations of the program, including hiring, training, fiscal management , utilization management , clinical oversight and regulatory ... within budget parameters. + Ensures program consistently achieves budgeted utilization and works with team to address any ...that are aligned with those of the organization. + Management : Aligns the right work with the right people;… more
- Molina Healthcare (Buffalo, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Hillside Family of Agencies (Rochester, NY)
- …communicated effectively to meet agency and regulatory requirements. + Facilitate Agency Utilization Management meetings to ensure residential youth continue to ... Collect, aggregate, and analyze data to identify unmet needs, utilization trends, and opportunities for improvement of existing services...that are aligned with those of the organization. + Management : Aligns the right work with the right people;… more
- Humana (Albany, NY)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a… more
- CVS Health (Albany, NY)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation… more
- Highmark Health (Albany, NY)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files,… more
- Molina Healthcare (NY)
- …comply with CMS guidelines. These staff may also be involved in providing utilization management /prior authorization services as needed. * Supervises the unit's ... (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy… more
- University of Rochester (Rochester, NY)
- …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … management rounds. + Provision of clinical oversight and leadership to Utilization Management /Case Management (UM/CM) staff working with the children's ... interpretation. + Develops and implements the BH sections of the Quality Management / Utilization Management (QM/UM) Plan, including having the BH Medical… more
- Villa of Hope (Rochester, NY)
- …with cultivation of referral sources; monitoring of cycle time for referrals/admissions; utilization management ; and documentation of services which aligns with ... Director will lead the planning and execution of strategy, operations, financial management , compliance, quality of care, and evaluation of outcomes for Tuckahoe… more