- CUNY (Brooklyn, NY)
- …and discretionary employee training and development activities; assist in the analysis, review , and utilization of confidential records, including those from New ... time charges are accurate and documented. - Prepares performance evaluations for review and approval by the Director, initiates disciplinary action when necessary,… more
- Elevance Health (New York, NY)
- …policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions listed ... decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review ...case review decisions that require Medical Director review or policy interpretation. + Determine medical necessity of… more
- Humana (Albany, NY)
- …of program changes and outcomes. Responsibilities include: + Oversee the development, review , and maintenance of Utilization Management (UM) policies and ... ranging from moderate to substantial. The Policy Governance Lead for Utilization Management (UM) is responsible for overseeing the development, implementation, and… more
- HTC Global Services Inc (Brooklyn, NY)
- …initiatives for telecom services. 4. Capacity Planning & Optimization Leadership + Review enterprise-level utilization trends for SIP channels, PRI circuits, WAN ... 7. Documentation, Asset & Lifecycle Management + Oversee creation and periodic review of telecom topology diagrams, circuit inventory, routing designs, and SOPs. +… more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... + Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to… more
- Unity House (Troy, NY)
- …integration and promote best practices in recovery-oriented, trauma-informed care. + Review and monitor utilization , documentation, and billing practices for ... compliance and efficiency. + Facilitate staff meetings, trainings, and performance reviews to promote professional development. + Foster a culture of accountability, collaboration, and continuous improvement within the program. + Monitor outcome data and… more
- St. Mary's Healthcare (Amsterdam, NY)
- …the referral the patient has presented. Schedules requested exams to maximize equipment utilization by time and location, review open slots and manage waitlist ... within Expanse. Communicates prep instructions and financial clearance to the patients, as required. Communicates successfully with Medical Imaging staff, surgical scheduler, doctor's offices and other providers as needed. Communicates changes in the patient… more
- Molina Healthcare (Albany, NY)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Arnot Health (Elmira, NY)
- …related to the management of patient care . The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... participates in them. . The Case Manager tracks and trends LOS , resource utilization , outliers, readmissions , denials , delay days and satisfaction of the case… more
- University of Rochester (Rochester, NY)
- …work with staff on resolving discrepancies. + Utilize Tableau reports for operations, utilization , and revenues. + Build/edit and review reports for various ... with Dept. Billing Manager regarding billing operations procedures + Analyze, review and distribute monthly billing and financial reports. + Ensure insurance… more