- Excellus BlueCross BlueShield (Rochester, NY)
- …This position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and healthcare services for members, ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member… more
- Arms Acres (Carmel, NY)
- …as identified in patient treatment plans and requested by program director. Performs utilization review , provides progress reports and develop aftercare plans in ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
- New York State Civil Service (Claverack, NY)
- …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... health and substance use screens, youth and collateral interviews, and record review to develop a psychosocial assessment and subsequent mental health treatment… more
- Arms Acres (Bronx, NY)
- …as identified in patient treatment plans and requested by program director. Performs utilization review , provides progress reports and develop aftercare plans in ... implementation of the multidisciplinary treatment plan; coordinates treatment plan review ; performs these activities within established time frames. Documents… more
- Highmark Health (Albany, NY)
- …cases, which may involve speaking with providers via phone.At times, build cases in Utilization Review system during high volume times. + May have responsibility ... audit issues to determine root cause of errors and recommend process improvements. Review error trends to identify training opportunities. + Other duties as assigned… more
- STG International (West Seneca, NY)
- …* Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... activities. * Ensure consistency in evidence-based practice standards across the CBOC's. * Implement and attend provider huddles to assure situational awareness of clinic operational limitations and daily work planning. * Function as a director for the CLIA… more
- Catholic Health Services (Uniondale, NY)
- …facilitates group counseling. + Plans effective and timely discharges based on utilization review criteria and communicates discharge planning with Program ... Recovery Plan goals and documents finding every two (2) days on Recovery Plan Review and daily or as needed in Progress Notes. + Maintains confidentiality of… more
- STG International (Kingston, NY)
- …+ Design and participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health enhancement ... activities. + Ensure consistency in evidence-based practice standards across the CBOC's. + Implement and attend provider huddles to assure situational awareness of clinic operational limitations and daily work planning. + Function as a director for the CLIA… more
- Catholic Health (Kenmore, NY)
- …(2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or ... Disease Manager, Population Health, Discharge Planning or Chronic Care Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case management skills critical to working on an interdisciplinary team + Has a good understanding of the Social Determinants of Health… more
- Wellpath (Valhalla, NY)
- …care through adherence to policies and procedures for admission and transfer, utilization review , and referrals. + Assumes responsibility and accountability for ... individual judgments andactions, andprovidesinput into mandatory committees as requested by superiors. **We are an Equal Employment Opportunity Employer** We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a… more