- BronxCare Health System (Bronx, NY)
- …assist the department's leadership develop strategies for denial prevention, improved utilization management , documentation of medical necessity and identify ... electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible… more
- Molina Healthcare (Buffalo, NY)
- …example, such meetings would occur to discuss and resolve issues related to utilization management , pharmacy, quality of care, and correct coding. * ... and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …eligibility. Applies scheduling priority guidelines, adheres to CC consult management timeliness metrics. Ensures designation of patient desired in-network community ... and schedule care with community providers. Effectively uses Provider Profile Management System (PPMS) when scheduling care in the community. Accommodates patient… more
- Elevance Health (Latham, NY)
- …management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. + ... with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Nurse Manager is responsible for the management of nursing practice and operations on a designated unit/service. This includes, but is not ... limited to, the management of: clinical nursing practice, staff recruitment, retention, labor...or she works closely with the Nursing Clinical Director, Physician Leader and staff in ensuring that the Service/Unit… more
- Albany Medical Center (Albany, NY)
- …members, and friends to advocate for our patients' needs. + Collaborate with Risk Management , Patient Relations, Utilization Management , Case Management , ... Department/Unit: Care Management /Social Work Work Shift: Day (United States of...of patient information, in addition to hospital and individual physician practice pattern data. Provides information and in services… more
- Mercy Flight Central (Rome, NY)
- …duties of a clinician pursuant to the standards as set forth by company management and the Department of Health. Summary of Essential Job Functions: + Participation ... of assigned "Shift Duties and Responsibilities" + Participation in company Quality Management program + 100% attendance at company meetings + 100% adherence to… more
- Mount Sinai Health System (Brooklyn, NY)
- **Job Description** The Nurse Manager I is responsible for the management of nursing practice and operations on a designated unit/service. This includes, but is not ... limited to, the management of: clinical nursing practice, staff recruitment, retention, labor...or she works closely with the Nursing Clinical Director, Physician Leader and staff in insuring that the Service/Unit… more
- Wolters Kluwer (Albany, NY)
- …including: + Conducting regular account review meetings and reviewing account utilization management reporting to provide recommendations + Overseeing contract ... front lines of clinical care. Our talented team of physician editors, technologists, and product visionaries collaborate to provide...+ Closely managing the deal through closure and keeping management informed of any risks or delays + Retaining… more
- STG International (Watertown, NY)
- …compliance and patient safety. * Design and participate in quality improvement, care management , risk management , peer review, utilization review, clinical ... and participate in the recruitment, and orientation of clinical staff physicians, physician assistants and nurse practitioners. * Collaborate with the CBOC Clinic… more