- Evolent (Albany, NY)
- …As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job Description + Reviews charts and analyzes… more
- Northwell Health (Melville, NY)
- …certifications as needed. + Inpatient clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + ... of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective … 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
- Evolent (Albany, NY)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company...I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools… more
- Sysco (Warners, NY)
- …Levels and works with site leadership to ensure work method and system utilization and compliance + Works with site leadership to improve overall warehousing ... and optimal slotting configurations. + Works with site leadership to ensure optimal utilization of Roadnet and ensure proper routing practices and policies are being… 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
- 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, process and procedures ensuring accurate member care needs… more
- Veterans Affairs, Veterans Health Administration (Batavia, NY)
- …to ensure documentation is accurate and reflective of the Resource Utilization Group (RUG) score. Responsible for providing competent, evidence-based care to ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Demonstrates leadership in delivering and improving holistic… more
- Evolent (Albany, NY)
- …cost & use projections, financial reconciliations, and providing insight in utilization drivers. + Consultative Leadership & Problem-Solving: Act as a thought ... seamlessly with diverse teams and stakeholders + Deep understanding of prior authorization processes, reporting, and key performance indicators (eg, approval rates,… more
- Molina Healthcare (Rochester, NY)
- …cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work hours ... for requested treatments and/or procedures. * Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. * Processes… more