- Elevance Health (Latham, NY)
- …or certification is a requirement for this position. + Previous experience in case management / utilization management with a broad range of experience with ... Health Care Manager II** is responsible for managing autism services and behavioral health treatment benefits through written review . **How you will make… more
- MVP Health Care (Tarrytown, NY)
- …with children and/or adolescents, with at least 2 years being ASD related + Utilization or Case Management experience in a managed care organization is preferred ... difference for our customers in every interaction **Your key responsibilities:** + Review all requests for behavioral health services utilizing the appropriate… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- MVP Health Care (Rochester, NY)
- …senior leaders to promote appropriate care quality, service utilization , medication utilization and adherence, care management , and cost control. + Through ... To achieve this, we're looking for a **Medical Director, Behavioral Health Children's Services** , to join #TeamMVP. If...of NYS child serving systems. + Experience with critical review in clinical scenarios is desirable. + Knowledge of… more
- OLV Human Services (Lackawanna, NY)
- …navigating electronic health record (EHR) for documentation of services rendered. + Review utilization and service provision with supervisor + Coordinate and ... spouse completes too! Salary range: $18.22 - $26.00 per hour. The Youth Behavioral Support Caseworker provides direct services to children and families in their home… more
- Molina Healthcare (Syracuse, NY)
- …healthcare services activities for care management , care review , utilization management , transitions of care, behavioral health, long-term services ... members within Molina's clinical/healthcare services function, which may include care review , care management , and/or correspondence processing, etc. *… more
- Garnet Health (Harris, NY)
- …Case Manager for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. Join the Garnet Health team and ... your career home with us as a Social Worker on our Inpatient Behavioral Health Unit (BHU) team at/in Garnet Health Medical Center-Catskill. Responsibilities The… more
- Highmark Health (Buffalo, NY)
- …OVERVIEW: * Receive, review and make determinations regarding physician reviewer assignments for medical management decisions. Cases requiring physician ... agencies' standards including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Committee (URAC), Pennsylvania Department of… more
- Molina Healthcare (Rochester, NY)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Highmark Health (Albany, NY)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more