- Evolent (Albany, NY)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet… more
- Molina Healthcare (Albany, NY)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with… more
- Molina Healthcare (Yonkers, NY)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Calvary Hospital (Bronx, NY)
- …identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review , Discharge Planning, Risk Management, and Quality Assessment and ... ESSENTIAL JOB FUNCTIONS: 1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed… more
- Evolent (Albany, NY)
- …focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates ... utilization management with collaborative engagement and innovation. **Core Responsibilities**...with collaborative engagement and innovation. **Core Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician… more
- CDPHP (Latham, NY)
- …to logging and routing requests for authorization to the appropriate clinical reviewer . CSS reviews clinical documentation and determines at times what is being ... (2) years experience in a health insurance related discipline required. + Utilization management experience is preferred. + Knowledge of managed care, health plan… 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
- Molina Healthcare (Albany, NY)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more