- Molina Healthcare (Yonkers, NY)
- …performing one or more of the following activities: care review/ utilization management ( prior authorizations, inpatient/outpatient medical necessity, etc.), ... state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet connectivity of… more
- Molina Healthcare (Yonkers, NY)
- …license in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Catholic Health (Buffalo, NY)
- …+ Two (2) years medical surgical nursing and/or job related experience + Preferred prior insurance /managed care/ utilization review experience in the role of a ... Hours: 8:00 am to 4:00 pm Summary: The Registered Nurse (RN) Care Manager- Utilization Review, as an active member of the Care Management and interdisciplinary care… more
- Bayer (NY)
- …teams monitor trends and utilization of patient support services and utilization management (ie: prior authorization submissions & approvals); + Partner with ... to maximize HP/PBM Pull Through opportunities; + Special emphasis on consistent utilization of DRPAs as conduit to field sales action, and opportunity Assessment;… more
- Evolent (Albany, NY)
- …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
- Molina Healthcare (NY)
- …state health plan's Healthcare Services (clinical operations) teams including Utilization Management ( prior -authorization, inpatient review) and Care Management ... unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality… more
- Excellus BlueCross BlueShield (Utica, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical… more
- Evolent (Albany, NY)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements. **Collaboration… more
- Centene Corporation (New York, NY)
- …to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine ... discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range: $22.00/hour ... and providing targeted feedback for continuous improvement. + Review funding prior to admission to ensure all appropriate documentation is presented. +… more