- Molina Healthcare (Syracuse, NY)
- …management, care review , utilization management, transitions of care, behavioral health , long-term services and supports (LTSS), and/or other program ... within Molina's clinical/healthcare services function, which may include care review , care management, and/or correspondence processing, etc. * Researches and… more
- Highmark Health (Albany, NY)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member… more
- CVS Health (Albany, NY)
- …Michigan, Virginia, Pennsylvania, and New Jersey** offering a variety of physical and behavioral health programs and services to its membership. Aetna is looking ... we have an Integrated plan. Experience with managed care (Medicare and Medicaid) utilization review preferred. **Education** MD (Doctor of Medicine) or DO… more
- City of New York (New York, NY)
- …integration, data management, stakeholder collaboration, and capacity building to enhance behavioral health services for pregnant and parenting caregivers. Job ... tools. Program Strategy & Service Expansion - Lead the expansion of behavioral health services for pregnant and parenting caregivers, integrating substance… more
- Highmark Health (Albany, NY)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Highmark Health (Albany, NY)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
- New York State Civil Service (Wassaic, NY)
- …in experimental psychology, research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance ... modeling, as well as discipline-specific projects, including assisting with enhancing utilization of electronic health records, * Participation in relevant… 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 ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… 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 ... and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… 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
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