- 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
- University of Rochester (Rochester, NY)
- …Identifies problems that include but are not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal ... and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management, Medicaid Enrollment & Outreach, patients, families, third-party payers,… 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)
- …+ Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. + ... the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members + Manages and coordinates patient care,… 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
- New York State Civil Service (Masonville, NY)
- …policy, treatment, and therapeutic programs, and serves on committees such as placement, utilization review , medical records review , and related committees, ... Pathologist 2, Teacher 4 (and all parenthetics), Training Specialist 1 (Nursing), and Utilization Review Coordinator. Additional Comments * If you are currently… more
- Rochester Regional Health (Rochester, NY)
- …with Directors of Nursing and Director of Quality to provide quality review activities. Guides assigned areas in utilization of recognized improvement ... Medicine and Surgery Service Line. Works collaboratively with operational leadership and physician leadership to develop budgets based on volumes and scope of… 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
- WMCHealth (Valhalla, NY)
- …and coding principles and guidelines; good knowledge of healthcare delivery system, utilization review , case review and quality improvement practice ... Applicant link Job Details: Job Summary: Provides clinically based concurrent review of patient medical records to ensure documentation accurately reflects the… more
- Nuvance Health (Rhinebeck, NY)
- …with emphasis on data management and reporting. Coordinates and manages all Utilization Review activities and works collaboratively with a multidisciplinary ... Responsibilities: * Coordinates inpatient denials for the hospital. * Organizes utilization review activities. * Coordinates workflow within the department… more