- Molina Healthcare (Yonkers, NY)
- …room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- New York State Civil Service (Albany, NY)
- …mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review . ? The ideal candidate(s) will have ... direct care and utilization management experience, including familiarity with the review of medical evidence, psychiatric evidence, a knowledge base of… more
- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director-Care Management Are you exceedingly driven, dedicated, and passionate...and appropriate documentation. Competencies + Priority Setting + Time Management + Action Oriented + Composure + Informing +… 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 ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- SUNY Upstate Medical University (Syracuse, NY)
- …Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, experience with ... with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the… more
- Evolent (Albany, NY)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Highmark Health (Buffalo, NY)
- …**Job Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent ... the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review . Ensures all accurate… more
- Highmark Health (Buffalo, NY)
- …Description :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review , status research, etc.… more
- Northwell Health (Melville, NY)
- …as needed. + Inpatient clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have ... level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective … 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 ... training.** 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… more