- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review/Quality Assurance Sr. Coordinator will be responsible for providing clinical information to managed care companies as requested ... to prevent denial of payment. Will assist/participate in special utilization studies/projects and the development of new programs/processes. Responsible for… more
- SUNY Upstate Medical University (Syracuse, NY)
- …and community-based partners to develop strategies to decrease unnecessary hospital ED utilization . In this position, the social worker will Identify utilization ... knowledge of social determinants, population health and drivers of utilization . Duties will include consultation through assessment, counseling, intervention,… more
- Catholic Health Services (Melville, NY)
- …to payers for non-scheduled admissions, and ensure pre-certification/authorization requirements are complete prior to the date of service. The role will work closely ... with Utilization Management, Patient Accounts, and other key stakeholders in...appropriately secure authorization in order to clear the account prior to service where possible. Works with denials reports… more
- Molina Healthcare (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
- Evolent (Albany, NY)
- …claims, membership data, and clinical outcomes to uncover cost drivers, utilization trends, and opportunities for integrated care solutions using SAS, SQL, ... years of analytics & reporting experience in healthcare, including medical economics, cost/ utilization analysis, and membership trend reporting. + 4+ years of SQL… more
- Rochester Regional Health (Rochester, NY)
- …the quality of care. The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate ... and contractual agreements. * Actively participates in analysis of utilization and quality trends and makes recommendations to management...degree in Nursing required for all Care Managers hired prior to August 1st, 2013. * 3 years of… 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
- 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
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