- Molina Healthcare (Rochester, NY)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... + Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria. Requests additional information… more
- Humana (Albany, NY)
- …communication skills. + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- Humana (Albany, NY)
- …communication skills . + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- Humana (Albany, NY)
- …communication skills. + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- Cree (Marcy, NY)
- …alignment and progress in industrial engineering projects. Analyzes work force utilization , work center layout, material flows, production costs, process flow and ... production requirements to determine the most efficient utilization of personnel and equipment. This Job is Right for You if You Have (Minimum Requirements): BS… more
- New York State Civil Service (Albany, NY)
- …their rated and non-rated service areas. * Perform monthly variance reporting on utilization and billing amounts. This may include providing DOB with annual billing ... and an outside vendor to develop annual service rates and complete the prior year rate reconciliation.* Assist the Accounts Receivable Unit in conducting aging… more
- Nuvance Health (Poughkeepsie, NY)
- …from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned ... and collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement. Utilizes criteria to confirm… more
- Evolent (Albany, NY)
- …+ Leading a team in the analysis and interpretation of cost and utilization data (medical and pharmaceutical) to explain potential upside/downside risks of a given ... track record of identifying insights from quantitative and qualitative data + Prior people management experience + Ability to work independently with limited… more
- Mohawk Valley Health System (Utica, NY)
- …responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision ... Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member care needs… more
- Rochester Regional Health (Rochester, NY)
- …and community resources. + Promote timely access to appropriate care. + Increase utilization of preventative care. + Reduce emergency room utilization and ... + Defines and directs patients and/or families to appropriate resource utilization . + Increase patients' ability for self-management and shared decision-making. +… more
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