- Mohawk Valley Health System (Utica, NY)
- …scheduling records. + Participates in agency meetings and the quality improvement and utilization review activities of the organization. + Follows all state, ... records. + Participates in agency meetings and the quality improvement and utilization review activities of the organization. + Follows all state, system and… more
- Highmark Health (Buffalo, NY)
- …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... for the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review . Ensures all accurate… more
- Highmark Health (Buffalo, NY)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review , status… more
- WMCHealth (Valhalla, NY)
- …of quality and cost improvement that is data driven and develops systems to review utilization of resources and measure outcomes of care. Monitors physician data ... in association with the DIO of NYMC + Reviews utilization of hospital clinical resources and provides guidance when...interpretation of trends to physicians and hospital committees for review . + Assures that quality management programs are carried… more
- Calvary Hospital (Bronx, NY)
- …Spending, Transit Check. + Free On-Site Parking Requirements Participates in the Utilization Review , Discharge Planning, Risk Management, and Quality Assessment ... NYS licensure. + Five (5) or more years experience in either Utilization Management, Quality Assessment and Improvement, Risk Management, and/or Discharge Planning… more
- Humana (Albany, NY)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Kaleida Health (Williamsville, NY)
- …plans/care paths are addressed and met. Serve as liaison to ancillary and utilization review services, serve as communication link between health team members. ... years) discharge planning, case management and home care required. Knowledge of Utilization Management. Use of computer applications related to health care industry… more
- Rochester Regional Health (Rochester, NY)
- …+ Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. + ... health. + Manages more complex assignments and larger caseloads with appropriate utilization of services. REQUIRED QUALIFICATIONS: + Level I - Diploma or Associate's… more
- Kaleida Health (Buffalo, NY)
- …In addition to daily oversight of operations, the VP will partner with Utilization Review , Revenue Cycle, and Clinical leadership to create patient/family ... preferred. RN licensure required.** **Experience** **10 years of care management/ utilization management experience required in hospital and/or ambulatory settings. 7… more
- FLACRA (Penn Yan, NY)
- …within the timelines outlined by FLACRA. + Participates in quality initiatives and utilization review activities as requested. + Strives to understand and meet ... the fiscal and financial parameters of practicing in the health care environment. + Provide administrative and/or clinical supervision to clinic staff as appropriate and in collaboration with clinic director. + Provides educational presentations and… more