- Trinity Health (Syracuse, NY)
- …stakeholder in the emergency room care transition team which includes nurse case managers, utilization review nurses, providers, and etc. whom all work to ensure ... the best care possible both for patients who require acute care and those who do not but require connections and pathways to care to improve outcomes in a fast paced environment. **EDUCATION, TRAINING, EXPERIENCE, CERTIFICATION AND LICENSURE:** Master's Degree… more
- CVS Health (Albany, NY)
- …and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination ... reviews and reviews of claim determinations. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. The Medical Director will provide… more
- Educational Alliance, Inc. (New York, NY)
- …appropriateness of the current level of treatment, corresponding with LOCADTR and utilization review instruments. + Coordinate integrated services with medical, ... mental health, vocational, recovery services, and other social service providers. + Complete detailed progress notes, comprehensive treatment plans, intake/admission assessments, psychosocial assessments, discharge plans, and other required documentation in… more
- Mohawk Valley Health System (Utica, NY)
- …+ Participates in appropriate agency meetings and the quality improvement and utilization review activities of the organization. + Supports the Agency's ... Compliance Program, ensuring that all information is kept confidential and is respectful of the Patient's Bill of Rights. + Complies with all MVHS and VNA policies and procedures, as well as applicable regulations. + Is flexible to work a varied schedule based… more
- Catholic Health (Buffalo, NY)
- …Two (2) years acute care RN experience required + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or Disease ... Manager, Population Health, Discharge Planning or Chronic Care Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case management skills critical to working on an interdisciplinary team + Has a good understanding of the Social Determinants of Health (SDOH) + Has… more
- Monte Nido (Glen Cove, NY)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... experience with Joint Commission and regulatory standards compliance is desired. + Ability to manage budgets and utilize KPIs (Key Performance Indicators) is preferred. + Experience in an Eating Disorder program or other residential behavioral health setting… more
- Kaleida Health (Buffalo, NY)
- …Weight Requirement - Sedentary (10 lbs)** **Job Details** Department: HPTE SNF Utilization Review Standard Hours Bi-Weekly: 75.00 Weekend/Holiday Requirement: No ... On Call Required: No **With Rotation:** No **Scheduled Work Hours:** 8a-4p Work Arrangement: Onsite Union Code: N00 - Non Union KH Requisition ID#: 3334 Recruiter: Daniel P. Conaway Jr Grade: EX214 Pay Frequency: Bi-Weekly **Salary Range:** $74,724.00 -… more
- Rochester Presbyterian Home (Rochester, NY)
- …and approved by RPH. + Reports findings to other departments such as utilization review , infection control, and risk management. + Responsible for ensuring ... all resident incidents are accurately documented in the medical record, logged for tracking purposes, and analyzed for root cause. All incident investigations shall be in writing and attached to a copy of the incident report. Incident investigative reports are… more
- Comunilife (New York, NY)
- …perform evaluations and maintain Comunilife policies and procedures, quality assurance, utilization review and outreach activities. The Program Coordinator will ... collaborate with the Sr. Vice President of Programs to assure quality psychiatric and psychosocial assessments are conducted prior to referral to the Life Is Precious Program. This position offers a generous benefit package including health insurance, dental,… more
- Comunilife (New York, NY)
- …Program Director to assure quality program service delivery and participates in Utilization Review /Quality Improvement process. + Participate in case finding, ... networking and outreach activities to increase clients' enrollment. + Works closely with agency's program directors to ensure assure continuity of care within the organization. Qualifications Education and Experience Requirement(s) + Associate's Degree in… more