- University of Rochester (Rochester, NY)
- …work is remote with some on-site requirements as needed. Qualifications: RN with Utilization Review experience preferred; 3-5 years of recent acute hospital ... Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management Work Shift: Range: UR URCB 213 Compensation Range: $69,326.00 -… more
- Humana (Albany, NY)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** ... of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity… more
- Molina Healthcare (Syracuse, NY)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Molina Healthcare (Yonkers, NY)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… more
- Molina Healthcare (Buffalo, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
- Molina Healthcare (Yonkers, NY)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal… more
- City of New York (New York, NY)
- …by the Unit. - Make recommendations to executive management to optimize staff utilization and review throughput. - Analyze roadblocks and troubleshoot complex ... the Agency. Your Impact: As the Director of Integrity Review Unit, you will serve under the direction of...Investigations and other enforcement entities. Your Role: The Integrity Review Unit includes the agency's Sponsor Review ,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of managed care products and… more
- Trinity Health (Troy, NY)
- …college level course in medical terminology. + One year of case management or utilization review /billing or coding experience. + One year of experience in ... records/billing or healthcare related field + One year of case management or utilization review , billing, or coding experience Please be aware for the safety and… more
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more