- Guthrie (Binghamton, NY)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates the physician and… more
- Mount Sinai Health System (Long Island City, NY)
- …interprets the clients responses to the plan of care. 11. 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
- 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
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work Type: ... Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology… more
- CDPHP (Latham, 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
- Stony Brook University (Stony Brook, NY)
- Registered Nurse 1 (T&RC) - Blood Donor Full -Time Day Shift **Position Summary** At Stony Brook Medicine, our Registered Nurses are critical members of the team who ... Required to perform Donor and Therapeutic Apheresis as assigned.. + Perform blood utilization quality assurance, donor related work as assigned. + Required to cover… more
- Guthrie (Binghamton, NY)
- …leadership and autonomy in nursing practice. + Preferred experience with care management/ utilization review , and payer knowledge. + RN considered. Education: + ... Medicare Annual Wellness Visit under the direct supervision of a physician ( physician on site) for beneficiaries to identify a personalized and individualized… more
- WMCHealth (Valhalla, NY)
- …the results. + Maintains familiarity with the laws, regulations, and interpretation of utilization review and discharge planning. Remains up to date on changes ... Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative...Department: Clinical Care Mgmt- WMC Health Union: No Position: Full Time Hours: M-F 9-5p Shift: Day Req #:… more
- Mount Sinai Health System (New York, NY)
- …to enhance an interdisciplinary approach to care delivery. + Performs a patient record review with the collaborating physician in a timely fashion but not less ... Title: Advanced Practitioner Provider Manager- Tisch Cancer Institute-Mount Sinai Hospital- Full Time - Day** The Advanced Practice Provider Manager-Nursing is… 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
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