- Catholic Health Services (Melville, NY)
- …Initiatives Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical ... York, as applicable. Certification by American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred. 4. Knowledge, Skills and… more
- Ellis Medicine (Schenectady, NY)
- …plan, implement and evaluate individual healthcare needs. Integrate Discharge Planning, Utilization Review and Performance Improvement activities at the patient, ... levels. Efficiently and effectively anticipates, identifies and resolves issues through utilization review and discharge planning processes. Collaborates with… more
- Rochester Regional Health (Rochester, NY)
- …soon as possible after admission-within the first 12 to 24 hours. Applies utilization review criteria to assess and document appropriateness of admission, ... coordination/patient navigation for patients, including triage management, algorithm management, utilization management and resource management. Organizes services across the… more
- Guthrie (Binghamton, NY)
- …(5) years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtain ... the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and other… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management.Company: Vassar Brothers Medical Center Org Unit: 1190 ... from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned… more
- Catholic Health Services (West Islip, NY)
- …with Hospital Conditions of Participation. Implements care management programs, including utilization review , intake and discharge planning. Evaluates patient ... collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals, Managed Care and Revenue Cycle and Patient… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision… more
- Kaleida Health (Buffalo, NY)
- …conventions and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. ... tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development… more
- Highmark Health (Albany, NY)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Elevance Health (New York, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more