- Helio Health Inc. (Syracuse, NY)
- …+ Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care , or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Hospital Description of Duties This position is in the Utilization Review Unit and functions as an...a professional nursing position involving responsibility for providing nursing care that may include bedside and/or clinical care… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... to MCC in response to physician order, or review of updated clinical information Acts as a resource...current with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …goal of sustaining high quality care /service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as ... needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you need: +… more
- Rochester Regional Health (Rochester, NY)
- …able to work independently with minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical problem solving. ... standard UM sources for potential inpatient medical necessity denials. Review patient class in the event manager ,... REQUIRED QUALIFICATIONS: + 3 years of acute hospital care , Case Management and/or Utilization Management experience… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front end operations of the Case Management Department by ... Word + Strong Communication skills Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West **Responsibilities** **A. Clinical/Technical/Service**… more
- CenterWell (Albany, NY)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional… more
- CenterWell (Albany, NY)
- …and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience +… more
- Guthrie (Binghamton, NY)
- …five (5) years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management ... Manager monitors clinical approaches and make recommendations for alternate levels of care . The Acute Case Manager collaborates cooperatively with the patient… more
- Stony Brook University (Stony Brook, NY)
- Care Manager - Per Diem **Position...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation ... Summary** At Stony Brook Medicine, a ** Care Manager ** is a valuable member of...cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to… more