- Rochester Regional Health (Rochester, NY)
- …necessity in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay ... in the expected time frame and with most efficient utilization of resources. Carries out activities related to ...continuum. + Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based… more
- City of New York (New York, NY)
- …maintain records of proposed and current Agency's Requirement Contracts. Ensure the utilization of these contracts by Procurement Liaisons. Review specifications ... Compliance and Opportunities, Purchasing Management, Accounts Payable Unit, Contracts Review and Negotiations, and the Process Optimization & Change Management… more
- City of New York (New York, NY)
- …maintain records of proposed and current Agency's Requirement Contracts. Ensure the utilization of these contracts by Procurement Liaisons. Review specifications ... Compliance and Opportunities, Purchasing Management, Accounts Payable Unit, Contracts Review and Negotiations, and the Process Optimization & Change Management… more
- Healthfirst (NY)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge planning, ... and case management as assigned. The Case Manager, Utilization Management is also responsible for efficient utilization of health services and optimal health… more
- Stony Brook University (Stony Brook, NY)
- …Revenue Cycle Management is responsible for the development, implementation, maintenance, review and audit of the Hospital Charge Description Master to optimize ... and education to Hospital departments, affiliates and other stakeholders. Requires utilization of coding guidelines, billing and payment regulations, and third party… more
- Mount Sinai Health System (New York, NY)
- …interprets the clients responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than every ... and other health team members. + Participates in peer review . + Incorporates research findings in clinical practice. +...Ability to interpret and apply principles of nursing research utilization . + Ability to manage and coordinate a patient… more
- Humana (Albany, NY)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Albany, NY)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Highmark Health (Albany, NY)
- …Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS, ... to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files, delivering… 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 ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more