- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly...transition of care with Social Worker + Serves as nurse consultant for Social Worker cases with Clinical or… more
- Bassett Healthcare (Cooperstown, NY)
- …a principle liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate bed ... IP CM/SW Communicate any urgent needs to IP CM/SW Utilization Review : Complete admission review ...and hospital protocols to make recommendations for unit placement Review traditional Medicare fee for service (FFS)… more
- Northwell Health (Staten Island, NY)
- …case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. + Keeps ... concurrent utilization management using Interqual criteria. + Conducts chart review for appropriateness of admission and continued length of stay. + Contacts… more
- Humana (Albany, NY)
- …to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare ) + Proven… more
- Molina Healthcare (Rochester, NY)
- **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides ... achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for… more
- 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 ... of admission and stay in accordance with Interqual. ** 2. Prepares Medicare /Non Medicare hospital notices of noncoverage (HINN) when patient's level… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare… more
- CenterWell (Hauppauge, NY)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Molina Healthcare (Syracuse, NY)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of… more
- Catholic Health Services (West Islip, NY)
- …with Hospital Conditions of Participation. Implements care management programs, including utilization review , intake and discharge planning. Evaluates patient ... but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals, Managed Care and Revenue Cycle...knowledge of NY Department of Health and Centers of Medicare and Medicaid regulations is required. Knowledge of Joint… more