- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Healthfirst (NY)
- …Peer Reviewer will:** + **Maintain productivity standards.** + **Collaborate with Utilization Management and Care Management and medical departments as ... **Duties//Responsibilities:** + **The Medical Peer Reviewer will assess// review requests for authorization,...Medicine or Family Practice** + **Previous, relevant experience in utilization management and clinical practice** + **Knowledge… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** Provide High Quality, Professional Utilization Management Services: (Medical necessity review ... benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review to… more
- Centene Corporation (New York, NY)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Helio Health Inc. (Syracuse, NY)
- …preferred. + Licensed /credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Centene Corporation (New York, NY)
- …Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical ... findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and… more
- New York State Civil Service (Orangeburg, NY)
- NY HELP No Agency Addiction Services and Supports, Office of Title Licensed Master Social Worker - HOURLY (Blaisdell ATC) Occupational Category Health Care, ... 57, Box 140 City Orangeburg State NY Zip Code 10962 Duties Description The Licensed Master Social Worker (LMSW) (Hourly) will serve as a member of a… more
- Bassett Healthcare (Cooperstown, NY)
- …consistent with ethical standards of practice in the field + Participates in the Utilization Review Process + Collaborates with outside agencies, such as CPS/DSS ... optimum health and enjoy the best quality of life possible. What you'll do The Licensed Social Worker is an active member of the psychiatry treatment team. The … more
- Centene Corporation (New York, NY)
- …Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Heritage Ministries (Jamestown, NY)
- …involved in the selection, promotion, training, and development of all direct report management personnel. Educate all management personnel on the philosophy of ... in the organization's commitment to its employees, residents, and larger community. + Review monthly facility operating and budgetary statements + Ensure the proper … more