- Centene Corporation (New York, NY)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent review, and retrospective clinical review team and ensures… more
- Evolent (Albany, NY)
- …contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Utilization ... Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the...as liaison between the Utilization and Appeals Management Department and the physician of record, as required.… more
- Arnot Health (Elmira, NY)
- … of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager 's average ... BSN prepared will be a leader in the Case Management practice. The Case Manager will work...nursing in acute care hospital setting or two years utilization management in an acute care hospital… more
- CVS Health (Albany, NY)
- …we do it all with heart, each and every day. **Position Summary** This ** Utilization Manager ** position is with Aetna's Long-Term Services and Supports (LTSS) ... with active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications** +… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an ... utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum...a. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management … more
- Guthrie (Binghamton, NY)
- …five (5) years of experience in an acute care setting with strong care management , utilization review, and payer knowledge. A Case Management certification ... Position Summary: The Acute Case Manager utilizes industry accepted processes for achieving optimal...members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria.… more
- Crouse Hospital (Syracuse, NY)
- …day management of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing ... outreach programs. Crouse's Care Coordination team is hiring a Manager who is responsible for providing day to day... who is responsible for providing day to day management of the RN Care Managers in the department.… more
- Guthrie (Corning, NY)
- …and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates ... Summary: In collaboration with the interdisciplinary healthcare team, the Case Manager will coordinate the flow of services throughout the patient's hospitalization… more