- CVS Health (Albany, NY)
- …+ 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/review experience preferred Outpatient Clinical ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . + Consults and lends expertise to other internal and external… more
- Molina Healthcare (NY)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Elevance Health (Latham, NY)
- …with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education ... be considered. This position will be directly responsible for Behavioral Health Utilization Management (BH UM) only The **Manager Behavioral Health Services** is… more
- Molina Healthcare (Albany, NY)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the unit's… 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
- Optimax Systems, Inc (Ontario, NY)
- …accomplishing related results as needed. Through On the Job Training (OJT) and utilization of prior experience, the Process Engineer will: + Evaluate ... and testing experience or ten (10) years industrial manufacturing experience desired + Prior experience in the production of precision optics desired + Prior … more
- Molina Healthcare (Buffalo, NY)
- …that support one or more of the following activities: care review/ utilization management ( prior authorizations, inpatient/outpatient medical necessity, etc.), ... of healthcare or health plan supervisory experience. Managed Care operations experience. Prior Medical Assistant experience. To all current Molina employees: If you… more
- Molina Healthcare (Buffalo, NY)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... and quality initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and cost control issues… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services ... requiring prior authorization. This includes approval determinations and appropriate exceptions,...a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review/Quality Assurance Coordinator is responsible for all compliance related paperwork and ensures all compliance paperwork is ... an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional… more
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