- Molina Healthcare (Buffalo, NY)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… 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 ... I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of managed care products and… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- Trinity Health (Syracuse, NY)
- …college level course in medical terminology.One year of case management or utilization review /billing or coding experience.One year of experience in ... records/billing or healthcare related fieldOne year of case management or utilization review , billing, or coding experiencePlease be aware for the safety and… more
- Mohawk Valley Health System (Utica, NY)
- …Med/Surg, Critical Care and other acute care services that functions as a reviewer , data abstracts, supports Medical Staff committees and various departments of the ... Preferred: + Knowledge of Quality Management, Performance Improvement and Utilization Management requirements and methodologies; including data abstraction and… more
- Stantec (New York, NY)
- …management process; reviews project deliverables before submitting to QA/QC reviewer . - Actively participates in the engineering/professional community to build ... seminars / conferences and/or write articles for trade magazines.) - Meets or exceeds utilization goals and adheres to project budget. - Performs duties to assist or… more
- 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
- Excellus BlueCross BlueShield (Buffalo, 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
- 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, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… 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. Manager ... 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