- Elevance Health (New York, NY)
- …+ Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + ... Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted… more
- Travelers Insurance Company (Albany, NY)
- …Medical Consortiums and other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. ... which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical… more
- Spectrum Health and Human Services (Buffalo, NY)
- …Care Coordinator will be responsible for the following outcomes: to reduce utilization associated with avoidable and preventable inpatient stays, to reduce ... utilization associated with avoidable emergency room visits, to improve...and improved health outcomes. + Consult with primary care physician and/or any specialists involved in the treatment plan.… more
- Kaleida Health (Buffalo, NY)
- …conventions and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management required. ... tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development… more
- Rochester Regional Health (Rochester, NY)
- …Life Support (BLS) certification PREFERRED QUALIFICATIONS + Acute care, chart review , utilization , or nursing triage experience strongly preferred. EDUCATION: ... to improve clinical practice. * Completes at least one clinical research utilization (CRU) form for submission to Nursing Research Department utilizing a research… more
- WMCHealth (Kingston, NY)
- …that performs a functional evaluation of the client; conducts the planning and utilization of a program of purposeful activities; implements the development and ... utilization of a treatment program, and/or consultation with the...be rendered on the prescription or referral of a physician , nurse practitioner or other health care provider acting… more
- Nuvance Health (Poughkeepsie, NY)
- …Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology ... care to an assigned group of patients through the utilization Standards of Practice and policies and procedures and...forces as requested. * Participates in the discussion and review of articles in the field of hyperbaric oxygen.… more
- Amgen (New York, NY)
- …HUB, providing live one-on-one coverage support + Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer ... prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested assistance… more
- University of Rochester (Rochester, NY)
- …and provide feedback on evaluations for direct and indirect reports. + Review and evaluate proposed promotions or terminations as appropriate. + Participate and ... and reviews timecards for accuracy to assist with payroll processing. + Review department budget for accuracy and provide feedback to increase efficiencies in… more
- CDPHP (Albany, NY)
- …clear understanding of prescription and medical benefits as it applies to the utilization review process. + Must demonstrate proficient experience with the ... 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