- Humana (Albany, NY)
- …Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management review organization ... us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments… more
- University of Rochester (Rochester, NY)
- …application of strict inclusion/exclusion criteria and protocols. Performs meticulous chart review and enters clinical data into the quality databases to identify ... for improved outcomes, reduced cost, improved LOS, and best practice utilization of resources. Performs complete and accurate collection of preoperative, operative,… more
- AON (New York, NY)
- …deliverables and goals identified each year. This may include billable hours and utilization goals. + Support senior members of the group in developing business ... existing client. + Train and mentor less experienced staff. Review their work product for reasonableness and accuracy to...identified each year. This may include billable hours and utilization goals. + Support senior members of the group… more
- Highmark Health (Albany, NY)
- …both internally developed and vendor-sourced criteria. This includes proactive monitoring, review , and timely updates in response to new evidence, regulatory ... data-driven insights from complex healthcare datasets (eg, claims, clinical, utilization , pharmaceutical) to inform policy development, identify areas for… more
- Northwell Health (Manhasset, NY)
- …and research. + Develops and monitors the hospital's policies/procedures regarding utilization of medications in collaboration with the medical staff, Pharmacy, and ... Therapeutics Committee; monitors medication utilization effectively and intervenes when necessary to ensure compliance. + Ensures the safe and effective use of… more
- Molina Healthcare (Rochester, NY)
- …rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + ... and other statistical methodologies to predict future trends in cost, utilization , and performance. + Assist with research, development and completion of… more
- LSI Solutions (Victor, NY)
- …by analyzing equipment layouts, workflow, assembly methods, and work force utilization . ESSENTIAL FUNCTIONS: Production Engineer I, II, III: + Provide technical ... of manufacturing processes within production; creates project plans, performs utilization studies, identifies capacity needs and constraints, and makes… more
- Healthfirst (NY)
- …+ Provide strategic oversight and operational management for all utilization management functions, including prior authorization, concurrent review , ... for audits, performance improvement plans, and corrective actions related to utilization management + Foster a culture of accountability, professional development,… more
- Catholic Health Services (West Islip, NY)
- …HAC Meeting, Hospital Performance Improvement and Patient Safety Committee, and Utilization Management Committee. + Participate in the development and furthering of ... for Risk Management activities and processes, such as Root Cause Analyses, to review and monitor the quality of care provided to patients and improve outcomes.… more
- BronxCare Health System (Bronx, NY)
- …the department's leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify patterns and ... completing job tasks. -Assists the Administrative Manager and Director with annual review and revisions of departmental policies, and procedures as required. -When… more