- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Stony Brook University (Stony Brook, NY)
- …design, development, implementation, and monitoring of the organization's case management and utilization review functions. + Lead initiatives to improve patient ... practice and collaboration with Social Work Services * Knowledge of Utilization Review and Denial/Appeals * Knowledge of Data Analytics **Special Notes** **:**… more
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and ... experience in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly preferred. Home… more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- CenterWell (Hauppauge, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review … more
- Northwell Health (Mount Kisco, NY)
- …RN Case Management and Social Work Services team. Develops processes to monitor utilization review inclusive of length of stay (LOS) and resource reduction ... facility best practices and makes recommendations for process improvement. Oversees resource utilization for the hospital and provides specific data analysis on … more
- Sedgwick (Albany, NY)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug… more
- Molina Healthcare (Yonkers, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... be licensed for the state they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer candidates with a… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more