- Catholic Health Services (Melville, NY)
- …hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the ... is responsible for assisting the both AVP and the Manager of Finance - Physician Strategy with the financial responsibilities of the Medical Group. Serves as the… 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
- Northwell Health (Mount Kisco, NY)
- …plans, implements and evaluates all activities of the inpatient RN Case Management and Social Work Services team. Develops processes to monitor utilization ... facility best practices and makes recommendations for process improvement. Oversees resource utilization for the hospital and provides specific data analysis on … more
- Veterans Affairs, Veterans Health Administration (Bronx, NY)
- …to improve processes to meet the performance measure goals (SAIL/EPRP) and improve utilization management ; reviewing requests and determining the best way to ... Model are required. VA offers a comprehensive total rewards package. VHA Physician Total Rewards. Pay: Competitive salary, annual performance bonus, regular salary… 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
- 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
- Elevance Health (New York, NY)
- …preferred. + Extensive spine surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. + **Orthopedic ... Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + Conducts… more
- Molina Healthcare (Yonkers, NY)
- …and/or Tableau and data management + Knowledge of healthcare operations ( utilization management , disease management , HEDIS quality measures, claims ... and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports… more
- Mount Sinai Health System (New York, NY)
- …and treatments plans are not required to be countersigned by a physician . **Qualifications** **EDUCATION REQUIREMENTS** 1. Licensure: New York State License with ... and recordkeeping (3-hour course). 5. Has a Collaborative Practice Agreement with a physician and designated protocols if less than 3600 hours experience as a… more
- CenterWell (Hauppauge, NY)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more