- Villa of Hope (Rochester, NY)
- …Ensures full participation of Tuckahoe staff in compliance, quality assurance, utilization review , and program evaluation activities. Maintains operating ... of referral sources; monitoring of cycle time for referrals/admissions; utilization management; and documentation of services which aligns with requirements… more
- Kaleida Health (Williamsville, NY)
- …2 years of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interqual Criteria set ... with members of the interdisciplinary team to coordinate care, facilitate utilization and resource management and discharge planning functions, working to achieve… more
- CenterLight Health System (Ridgewood, NY)
- …of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably ... clinical onboarding and reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager… more
- FlexStaff (New York, NY)
- …of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge planning (preferably ... clinical onboarding and reassessment, UAS-NY completion, comprehensive assessment, medication review , and post-hospital discharge evaluation. The Clinical Assessment Manager… more
- New York State Civil Service (Syracuse, NY)
- …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... as a member of an interdisciplinary treatment team and attend meetings for case review ; * Participate in and lead individual, family and group counseling sessions; *… more
- Arnot Health (Elmira, NY)
- …Bachelor's in nursing preferred. Must have proficient writing skills.Experience in Utilization Review and InterQual required. CARDIOPULMONARY RESUSCITATION (CPR) ... Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and… more
- STG International (Watertown, NY)
- …safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... of Quality Performance Improvement Team (QPIT) strategic initiatives. + Participate in review and improvement of clinical success in of areas of responsibility. +… more
- WellLife Network (South Richmond Hill, NY)
- …location and schedules are subject to change. + Attend certification inspections, utilization review and independent professional reviews as needed. + Attend ... medical pre-admission evaluations and screening of prospective clients. + Review and update persons with disabilities pre-admission evaluation within thirty… more
- Evolent (Albany, NY)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review determinations and… more
- Molina Healthcare (Yonkers, NY)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...also entails producing audit reports for internal and external review . The position may also work with other internal… more