- Molina Healthcare (Albany, NY)
- …in a medical unit or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- Molina Healthcare (Rochester, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
- Molina Healthcare (Buffalo, NY)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- FLACRA (Penn Yan, NY)
- …within the timelines outlined by FLACRA. + Participates in quality initiatives and utilization review activities as requested. + Strives to understand and meet ... Integrated Outpatient Senior Clinician FLACRA Penn Yan, NY (Onsite) Full-Time $34.00/Hour...plus. Valid NYS driver's License. Job Summary:The integrated senior clinician is a clinician with demonstrated leadership… 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
- Elevance Health (Latham, NY)
- …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... The **Medical Management Clinician Associate** is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information… more
- Datavant (Albany, NY)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers + Provide proper… more
- Garnet Health (Harris, NY)
- …Case Manager for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. Join the Garnet Health team and ... organize/prioritize accordingly, and implement evidence based care. Social Work Clinician /Case Manager - primary role is to provide psychiatric/detox emergency… more
- Albany Medical Center (Albany, NY)
- …a changing environment. + Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more