- Arnot Health (Elmira, NY)
- …processes related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The ... population. ** 7. In conjunction with the patient/family, other members of the health care team, the payer, and available resources, formulates a plan to address… more
- Catholic Health Services (Melville, NY)
- … system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the ... Overview Catholic Health is one of Long Island's finest ...Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC… more
- Humana (Albany, NY)
- …quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- University of Rochester (Rochester, NY)
- …Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500183 Health Insurance Counseling Work Shift: UR - Day (United States of America) ... employers, social work, financial case management, clinical team and contracting. The Health Insurance & Auth Rep is ultimately responsible for minimizing any delays… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …professional and community standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those cases in ... and support for the development and implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has… more
- Evolent (Albany, NY)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the SVP, CCO and/or CMO. +… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management.Company: Vassar Brothers Medical Center Org Unit: 1190 ... within the assigned caseload. Partners with Social Workers and collaborates with other health care team members to identify appropriate utilization of resources… more
- Spectrum Health and Human Services (Buffalo, NY)
- …need. + Maintains complete, current and accurate member files which comply with The Health Home Standards. Documents all member related activity in a progress ... Agency Profile: Spectrum Health & Human Services respectfully partners with adults,...will be responsible for the following outcomes: to reduce utilization associated with avoidable and preventable inpatient stays, to… more
- City of New York (New York, NY)
- …much of NYC's comprehensive network of child and adolescent community mental health services. CYF-DD relies on research and surveillance to guide its decisions ... around service planning, implementation and evaluation and incorporates a health equity lens into its work. CYF-DD oversees a...large DOHMH programs, such as: (a) The New Family Home Visits program that offers support, services and referrals… more
- CenterLight Health System (Ridgewood, NY)
- …five (5+) years of experience in care/case management, disease management, population health management, utilization review , quality assurance, or discharge ... planning (preferably within a managed care, home care, or community health organization). + Proficiency in utilizing and analyzing UAS-NY and Lenavi. +… more