- Catholic Health Services (Melville, NY)
- …clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required. Communicates ... changes from the Managed Care Department and applies to UM and appeals management processes. Works collaboratively with physicians, physician office staff and… more
- Catholic Health Services (Melville, NY)
- … Advisors during the monthly Physician Advisor meeting. Attends hospital Utilization Management (UM) committees. Supervises the Facility Physician ... develops standard system-wide implementation plans and policies. Works with system Care Management (CM) leadership and Catholic Health Physician Advisors (as… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - ... Responsibilities include concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a...to payers/audits. + Participates in periodic denial meetings with Physician Advisors to review the denials that do not… more
- Guidehouse (New York, NY)
- …nursing. + New York Nursing License - REQUIRED + 4+ years of experience in utilization management + Familiarity with MCG and InterQual guidelines + Ability to ... appropriateness for inpatient level of care or observation services based on physician certification + Gathers clinical information to conduct continued stay … more
- Guthrie (Binghamton, NY)
- …necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this ... Provides health care services regarding admissions, case management , discharge planning and utilization review....Employer. The Guthrie Clinic is a non-profit, integrated, practicing physician -led organization in the Twin Tiers of New York… more
- CDPHP (Albany, NY)
- …is required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is ... for a rewarding career. Established in 1984, CDPHP is a physician -founded, member-focused, and community-based not-for-profit health plan that offers high-quality… more
- Evolent (Albany, NY)
- …reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business Managers to ... well as health plan members and staff whenever a physician `s input is needed or required. Responsible for clinical...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- WMCHealth (Valhalla, NY)
- …role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes. Responsibilities: + Reviews ... on UM Committee .Provides Physician administrative support and leadership to the utilization and resource management areas of Integrated Case Management … more
- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- …achieve goals for eligibility, referral and authorization, care coordination, and utilization management to ensure improved Veteran experience. Makes ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization… 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 ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job...PREFERRED: + Certification preferred or eligibility for certification in utilization management via certifying boards within 1-2… more