- 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
- Mount Sinai Health System (New York, NY)
- …interprets the clients responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than ... to established standards as part of initial orientation and annual performance review with collaborating physician or appropriately credentialed designee. +… 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. ... 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
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Perform medical review activities pertaining to utilization review , quality ... + Assist the VPMA in the functioning of the physician committees including committee structure, processes, and membership. +...with respect to clinical issues and policies. + Identify utilization review studies and evaluates adverse trends… 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: 1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Evolent (Albany, NY)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... of Medicine or Doctor of Osteopathic Medicine. + The Physician is not the subject of any pending professional...+ Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge… more
- Molina Healthcare (Albany, 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
- Rochester Regional Health (Rochester, NY)
- …of patients across the continuum. + Appropriately identifies and refers cases to the Review Physician Advisor to validate level of care based on medical ... necessity in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay… more