- Guthrie (Binghamton, NY)
- …health care services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and ... for a rewarding career. Established in 1984, CDPHP is a physician -founded, member-focused, and community-based not-for-profit health plan that offers high-quality… more
- Catholic Health Services (Melville, NY)
- …queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, ... was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews...and level of care to MCC in response to physician order, or review of updated clinical… 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 IDepartment: 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
- Guidehouse (New York, NY)
- …on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and...policies and timelines + Adheres to CMS guidelines for utilization reviews as evidenced by utilization of… 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
- WMCHealth (Valhalla, NY)
- …management areas of Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. + Reviews cases ... objectives. This position plays an important role in ensuring physician support and execution of for Utilization ... guidelines and parameters to assure consistency in the review process to reflect appropriate utilization and… more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of...and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides… more
- Veterans Affairs, Veterans Health Administration (Montrose, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... goals for eligibility, referral and authorization, care coordination, and utilization management to ensure improved Veteran experience. Makes recommendations for… more
- Catholic Health Services (Melville, NY)
- …Initiatives Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical ... York, as applicable. Certification by American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred. 4. Knowledge, Skills and… more