- 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 case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review ....job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Albany, NY)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Outreach Development Corporation (Brentwood, NY)
- …House Program Description + Facilitates case conferences, level of care assessments and utilization review in a timely manner and maintains record of old ... that helps people address the issues stemming from substance use and behavioral health disorders by providing the highest quality, life-changing treatment, training… more
- FLACRA (Penn Yan, NY)
- …progress notes and other documentation required for the client medical record and utilization management within the timelines outlined by FLACRA. + Participates ... + Monitors, support, and mentors clinicians in their practice management to meet expectations for excellent client care. +...in quality initiatives and utilization review activities as requested. + Strives… more
- City of New York (New York, NY)
- …data management , stakeholder collaboration, and capacity building to enhance behavioral health services for pregnant and parenting caregivers. Job Duties and ... stakeholders to enhance data-driven decision-making and cross-system referrals. - Review , synthesize, and report data findings, providing actionable recommendations… more
- Whitney Young Health Center (Albany, NY)
- …to continually assess and improve the quality of patient services-conducts monthly utilization review . + Participates in the recruitment of clinical staff. ... serves as a member of the Integrated Outpatient Substance Use Program(s) management team and is responsible for assisting the director with the oversight,… more
- Highmark Health (Albany, NY)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... terms through regular on-site audits. Apply an active role in network management , training, monitoring and enforcement of company policies and procedures while… more
- GMHC (New York, NY)
- …Rapid Rehousing and Permanent Supportive Housing, HASA scatter-site housing, Financial Management Rent Payee program and SURE Housing program. These programs are ... integrated with case-managed services, financial coaching, behavioral health supports, and community partnerships that reflect GMHC's "Housing is Healthcare" model.… more
- Bassett Healthcare (Cooperstown, NY)
- …consistent with ethical standards of practice in the field . Participates in the Utilization Review Process . Collaborates with outside agencies, such as CPS/DSS ... consistent with ethical standards of practice in the field . Participates in the Utilization Review Process . Collaborates with outside agencies, such as CPS/DSS… more
- Nuvance Health (Carmel, NY)
- …quality indicators such as avoidable delays, length of stay, resource utilization , patient satisfaction, patient flow, outlier management , and readmissions ... services a community needs from their local hospital, including Emergency and Behavioral Health Services. Our accolades include: * The Leapfrog Group - Grade… more