- Catholic Health Services (Roslyn, NY)
- …and monitors staff satisfaction. + Assures compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, ... reporting data on utilization trends, resource utilization and denials. + Serves as a resource to physicians, physician advisors, CM department, and hospital… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include the supervision… more
- New York State Civil Service (Albany, NY)
- …or improve children's intensive outpatient community based mental health services. Review data reports, such as utilization rates, patient characteristics, ... working with children and/or adolescents with mental illness, as well as utilization management experience, including familiarity with the review of medical… more
- Highmark Health (Albany, NY)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- New York State Civil Service (Albany, NY)
- …improvement, focus on prioritization and areas to be addressed through collaborative review and utilization of available data.* Serve as physician advisor ... Services.* Provide clinical recommendations to the Bureau of Service Allocation Research and Review (BSARR) regarding cases that do not meet standard level of care… more
- University of Rochester (Rochester, NY)
- …written and verbal communication and customer service skills. _Financial Management_ + Review each visit for insurance history by utilizing the hospital system along ... Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain a… more
- Oracle (Albany, NY)
- …stays. + Knowledge of third-party payor rules and regulations. + 2-3 years of Utilization Review experience in a healthcare setting preferred; 1-2 years of ... college and AHIMA Certified RHIT credentials preferred + Certification in Utilization Review , case management, and healthcare quality preferred… more
- Highmark Health (Albany, NY)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- City of New York (New York, NY)
- …coordination, lease and property management, land use and environmental review activities, contract administration for facilities services, and warehouse operations. ... all difficult and responsible architectural work associated with the preparation, review , and management of the Agency's construction program. - Develop project… more
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