- Evolent (Albany, NY)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...and findings with matrixed Physician Business Manager . + Provides medical direction to… more
- Catholic Health (Buffalo, NY)
- …years acute care RN experience required + 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... Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case management skills critical to working on an interdisciplinary… more
- Rochester Regional Health (Rochester, NY)
- …necessity in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay ... 3 years acute hospital care experience not required. PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience preferred. + Bachelor's… more
- Kaleida Health (Williamsville, NY)
- …of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interqual Criteria set and ... degree in Nursing required within five (5) years of hire to the position. Certified Case Manager (CCM) preferred. Employees in the job title prior to 3/29/10 are… more
- Global Foundries (Malta, NY)
- …requirements and their implications. 2. PFAS in wastewater data analysis and review Collecting data, providing information and reports as needed to support ... automatically populate in every external job description. The Hiring Manager only needs to provide the above pieces of...information. Requests for accommodation will be considered on a case -by- case basis. Please note that only inquiries… more
- Elevance Health (New York, NY)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- City of New York (New York, NY)
- …system concerns and issues to the Assistant Program Manager to ensure effective utilization of resources. - Review and audit selected records of two to three ... Determine training needs based on information obtained from internal audits and case review and share with unit supervisors for corrective actions. Ensure that… more
- Kaleida Health (Buffalo, NY)
- …of experience in any combination of case management, home care and utilization review preferred. Knowledge of and experience with Interquel Criteria set and ... degree in Nursing required within five (5) years of hire to the position. Certified Case Manager (CCM) preferred. Employees in the job title prior to 3/29/10 are… more
- RiseBoro Homecare Inc. (Brooklyn, NY)
- …duties and responsibilities include: + Serve as part of a team comprised of Case Manager , Health Services Coordinator, and program supervisors to serve frail ... how to manage chronic conditions + Together with the Case Manager , provide education on insurance options...to clients as needed + Assist clients with medication review and understanding directives from Primary Care Physicians (PCPs)… more
- Garnet Health (Harris, NY)
- …effectively organize/prioritize accordingly, and implement evidence based care. Social Work Clinician/ Case Manager - primary role is to provide psychiatric/detox ... plan. The SW Clinician will also be the primary Case Manager for the detox patient on...detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. At Garnet… more