- Excellus BlueCross BlueShield (Rochester, NY)
- …for all Medicare Part D formulary creation and submissions, which includes utilization management criteria development for the current and upcoming contract ... are met. Works in conjunction with the Pharmacy Benefit Manager (PBM) and Formulary Management software vendor...Creates and operationalizes Medicare Part D criteria for all utilization management requirements in alignment with the… more
- Ellis Medicine (Schenectady, NY)
- …provided by the Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration with physicians and social ... SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for case management ...discharge planning guidelines and departmental/organizational policies and processes + Utilization Management : + Ensures order in chart/EMR… more
- BronxCare Health System (Bronx, NY)
- …assist the department's leadership develop strategies for denial prevention, improved utilization management , documentation of medical necessity and identify ... Overview The Appeals Manager is responsible to assist in the analysis...avoidable day and barriers to discharge processes pertaining to utilization management . - Liaisons and coordinates with… more
- Guthrie (Binghamton, NY)
- …staff, exhibiting the Core Values in all activities. Mentors under the Clinical Manager / Director and pursues management and leadership training within the ... issues, and risk management concerns. + Acts on behalf of Clinical Manager / Director in his/her absence, attending meetings and making decisions as appropriate… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Supply Chain Clinical Category Manager provides on-going oversight and analysis of clinical products and services. Will review usage ... for assigned categories are being achieved. Conducts on-going reviews of utilization trends including usage off-sets from competitive vendors where product… more
- UPMC (Pittsburgh, PA)
- …the direct oversight of the day-to-day operations of the authorization, denial management , and/or utilization review functions of UPMC Revenue Cycle, involving ... Purpose: UPMC is hiring a full-time Clinical Manager , Revenue Cycle CCM to support the Pre-Arrival...+ Function as a resource person for authorization, denial management and/or utilization review processes. + Assess… more
- Sevita (Lompoc, CA)
- …Join us today, and experience a career well lived. SUMMARY The Day Program Manager is responsible to manage the services delivered to a designated program or set ... care, advocacy, stakeholder relations, regulatory compliance, staffing, training, financial management and maintenance of the physical environment. ESSENTIAL JOB… more
- Sevita (Fontana, CA)
- …and experience a career well lived. Annual Salary: $58,240 SUMMARY The Day Program Manager is responsible to manage the services delivered to a designated program or ... care, advocacy, stakeholder relations, regulatory compliance, staffing, training, financial management and maintenance of the physical environment. ESSENTIAL JOB… more
- J&J Family of Companies (Rochester, NY)
- …States **Job Description:** We are searching for the best talent for Account Manager to be in Rochester/Syracuse, NY. **About Surgery** Fueled by innovation at the ... their journey to wellness. Learn more at https://www.jnj.com/medtech As a Field Sales Account Manager , this individual will serve as the point person for end to end… more
- Magellan Health Services (Shreveport, LA)
- …health care setting. Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...an active work load in accordance with National Care Manager performance standards. + Works with community agencies as… more