- Evolent (Albany, NY)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with… more
- Molina Healthcare (New York, NY)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... cases. you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager ... are not limited to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Kaleida Health (Williamsville, NY)
- …Suite and Outlook. 2 years of experience In any combination of: case management, home care and utilization review preferred. Knowledge of and experience ... with Interqual Criteria set and software systems preferred. 2 years of experience of supervisory experience preferred.** Working Conditions **Job Details** Department: MFS Patient Management Standard Hours Bi-Weekly: 37.50 Weekend/Holiday Requirement: No On… more
- Mount Sinai Health System (New York, NY)
- …Masters preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... are not limited to:** + Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- CenterWell (Albany, NY)
- …Clinical Pharmacist develops, maintains, and/or operationalizes strategies related to utilization management edits and/or clinical coverage policies for pharmacy and ... clinical reviews, policy development and recommend drug coverage and potential drug utilization tools to mitigate Humana's cost and trend while improving our… more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Rehab you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more