- Excellus BlueCross BlueShield (Rochester, NY)
- …encourage you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and ... outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center… more
- University of Rochester (Rochester, NY)
- …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
- University of Rochester (Rochester, NY)
- …documentation required to complete the precertification process AND Communicates with Utilization Management and Financial Counseling throughout the admission to ... IRF-PAI + Maintain and access data to analyze clinical utilization and costs (10%) + Measure and maintain clinical...ensure payment for rehab services (5%) **QUALIFICATIONS** + Associate's degree in business field… more
- Molina Healthcare (Manhattan, NY)
- …example, such meetings would occur to discuss and resolve issues related to utilization management , pharmacy, quality of care, and correct coding. * ... that services Molina members, including but not limited to Fee-For- Service and Pay for Performance Providers. It is an external-facing, field-based position… more
- VNS Health (Manhattan, NY)
- …leadership to develop and implement plans to meet needs. + Provides guidance and consultative services to Utilization Management (UM) and Care Management ... medical cases. Participates in the QARR/HEDIS Quality Improvement Activities and utilization management of the population. Works under limited direction.… more
- Centers Plan for Healthy Living (Queens, NY)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management nurse works within a multidisciplinary team to help identify ... their home to improve their quality of life. The Utilization Management nurse will assess and process...are maintained. PRIMARY RESPONSIBILITIES: + Authorization of medically necessary services in coordination with the care management … more
- Ellis Medicine (Schenectady, NY)
- … discharge planning guidelines and departmental/organizational policies and processes + Utilization Management : + Ensures order in chart/EMR coincides with ... are consistent with the patient's required needs and covered services . Support services provided by the Case...the Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration… more
- Mount Sinai Health System (New York, NY)
- … + Lead and participate in pharmacy resident conference **Responsibility #4 Quality/ Utilization Management ** + Assist with scaling MTM and chronic disease ... of the Clinical Pharmacy Integration team will be responsible for medication management quality, cost, utilization and clinical stewardship activities at… more
- New York State Civil Service (Albany, NY)
- …adolescents with mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review. ? The ideal candidate(s) ... Grade 23, position in the Division of Integrated Community Services for Children and Families, RTF Authorizations and Admissions...will have direct care and utilization management experience, including familiarity with the… more
- Catholic Health Services (Melville, NY)
- …is initiated within 24 hours of admission / arrival. Coordinate with onsite Case Management and Utilization Management to guarantee payer requirements are ... acute care hospitals, three nursing homes, a home health service , hospice and a network of physician practices across...departments to ensure consistent financial clearance of FCC in-scope services . Foresee and communicate to management team… more