- SUNY Downstate Health Sciences University (New York, NY)
- …requirements, and regulatory compliance. CDI: Collaborate with CDI to ensure appropriate physician documentation with a goal to improve utilization , CMI, and ... Physician Advisor / Clinical Assistant Professor (HS) Apply...optimizing healthcare delivery by providing guidance on medical necessity, utilization management, and quality improvement initiatives. They collaborate with… more
- Evolve Treatment Centers (West Islip, NY)
- …the supervision of the clinical staff. He/she consults with the Clinical Director, CEO, Physician , and Utilization Review Department as needed. The Clinical ... of quality and effectiveness. Coordinates with program administration. Works with Utilization Review Department. Organizes professional development and training… more
- Evolve Treatment Centers (Clay, NY)
- …to maintain the highest standard of quality and effectiveness. Consults with CEO, Physician , and Utilization Review Department as needed and maintains ... function of the facility. Coordinates with program administration. Works with Utilization Review Department. Organizes professional development and training in… more
- Evolve Treatment Centers (Yorktown Heights, NY)
- …responsible for the supervision of the clinical staff. He/she consults with the CEO, Physician , and Utilization Review Department as needed. The Clinical ... of quality and effectiveness. Coordinates with program administration. Works with Utilization Review Department. Organizes professional development and training… more
- UnitedHealth Group (New York, NY)
- …CA, OR, WA or AZ licensure or willing to obtain Experience in utilization and clinical coverage review Proven excellent oral, written, and interpersonal ... experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible… more
- Med-Metrix, LLC (New York, NY)
- …data into the computer systems accurately relevant to all Case Management activities, Utilization Review and other items managed by the Case Management ... a clinical resource and lend guidance to staff in utilization management, discharge planning, and care coordination issues Provide...patient; Meet with Case Managers and Social Workers to review medically complex and long stay cases and refer… more
- Rochester Regional Health (Rochester, NY)
- …able to work independently with minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical problem solving. ... Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per...to payers/audits. + Participates in periodic denial meetings with Physician Advisors to review the denials that… more
- Evolent (Albany, NY)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization … more
- Highmark Health (Albany, NY)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... the physician against medical policy criteria. The incumbent then uses...prior authorization or appeals against medical policy through the Utilization Review system. Update the system records… more
- Ellis Medicine (Schenectady, NY)
- …of Care and status on all patients through collaboration with Utilization Review RN + Contacts the attending physician for additional information if the ... the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration...of discharge plan + Collaborates and makes referrals to physician advisor when unable to resolve issues with attending… more
