- Centene Corporation (New York, NY)
- …related to member care, provider interactions, and facilitates operations within utilization management. + Manages prior authorization, concurrent review, and ... 8:30 am - 5:00 pm with holiday rotation.** **Position Purpose:** Manages Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to… more
- Molina Healthcare (Buffalo, NY)
- …data to identify behavioral health cost-savings opportunities, quality improvements, and utilization trends (eg, prior authorizations, outlier management). + ... contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective quality outcomes in a… 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 (15) years industrial manufacturing experience desired + Prior experience in the production of precision optics desired + Prior … more
- CenterWell (Albany, NY)
- …& Reporting: Define and track KPIs related to referral throughput, network utilization , and prior authorization efficiency; use data to drive continuous ... Care to lead strategy and execution for our referral management, payer prior authorization, and specialist network solutions. This role is critical to shaping… 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
- Guthrie (Cortland, NY)
- …Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior ... those with less than one year of experience) Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices,… more
- Humana (Albany, NY)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity ... and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying… more
- Highmark Health (Albany, NY)
- …**JOB SUMMARY** This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review ... RESPONSIBILITIES** + Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the … more
- Healthfirst (NY)
- …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests + Develop strong ... to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead… more
- Molina Healthcare (Buffalo, NY)
- …an intensive care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... for requested treatments and/or procedures. * Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. * Processes… more