- Healthfirst (NY)
- …+ Provide strategic oversight and operational management for all utilization management functions, including prior authorization, concurrent review, ... for audits, performance improvement plans, and corrective actions related to utilization management + Foster a culture of accountability, professional development,… more
- Northwell Health (Forest Hills, NY)
- …preferred.Minimum five (5) years clinical experience as a registered nurse. Prior experience in utilization management and/or discharge planning, preferred. ... Applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning. Job Responsibility 1. Coordinates and facilitates… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, ... Level I + Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include:… more
- Evolent (Albany, NY)
- …for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your… more
- Evolent (Albany, NY)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more
- Evolent (Albany, NY)
- …As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more
- RxBenefits (New York, NY)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical...review calls with EBC. + Manage pricing refreshes for prior opportunities. + Contribute heavily toward the addition of… more
- Ellis Medicine (Schenectady, NY)
- …provided by the Case Manager include, but are not limited to, utilization review, case management, care transition, collaboration with physicians and social workers ... experience in a hospital environment preferred. + Previous case management, utilization review, and discharge planning experience highly preferred. Home care, payer,… more
- Evolent (Albany, NY)
- …Medical Director, Physical Medicine and Rehab you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more
- Evolent (Albany, NY)
- …Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more