- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …delivery of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
- Molina Healthcare (Buffalo, NY)
- …and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health, Quality Management , ... and review timeliness, workflow volumes, referrals generated to care management programs + Provides administrative support to the grievance and appeals process… more
- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Molina Healthcare (Bronx, NY)
- …member care. Essential Job Duties * Performs audits in utilization management , care management , member assessment, behavioral health, and/or other ... suite/applicable software program(s) proficiency. Preferred Qualifications * Utilization management , care management , behavioral health and/or long-term… more
- CenterWell (Albany, NY)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Humana (Albany, NY)
- …management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Molina Healthcare (Buffalo, NY)
- …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization… more
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