- Molina Healthcare (Albany, NY)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests… more
- Molina Healthcare (Yonkers, NY)
- …holidays.** Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- CVS Health (Albany, NY)
- …in Health Care Delivery System eg, Clinical Practice and Health Care Industry. * Prior UM ( Utilization Management) experience *Active and current state medical ... license without encumbrances *M.D. or DO, Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience. **Preferred Qualifications** Active and current state medical license in CA without encumbrances and… more
- Centene Corporation (New York, NY)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of… more
- University of Rochester (Rochester, NY)
- …services and to ensure that the appropriate referrals are received prior to service. **ESSENTIAL FUNCTIONS** **_Personnel Management_** + Oversee the supervisors ... Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records, Home Care… more
- Catholic Health Services (Port Jefferson, NY)
- …for Care Management 3+ Years acute care clinical RN experience required Prior RN experience in Utilization Management, Performance Improvement, Transition ... across the acute care continuum. Perform required activities for utilization management, PRI assessment and completion, transition planning, and identification… more
- Molina Healthcare (Syracuse, NY)
- …an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Pfizer (New York, NY)
- …+ Proficient report writer. + Prior experience in budget management. + Prior exposure to and utilization of intelligence analysis. + Good computer skills. ... + Excellent communication skills with emphasis on security presentations/briefings for Executives and Staff. + Excellent people skills - ability to coordinate and collaborate with executive leaders, leadership's staff, security professionals and business… 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)
- …the mission. Stay for the culture. **What You'll Be Doing:** **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
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