• Utilization Management…

    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
    Excellus BlueCross BlueShield (05/29/25)
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  • Care Management Representative

    Saratoga Hospital (Saratoga Springs, NY)
    …Utilizes MCG- Milliman criteria to identify severity of illness & intensity of service for appropriate utilization management and 1st level criteria ... Care Management Representative Location: Saratoga Hospital, 211...the Collaborative Practice Groups, Magnet Councils, Interdisciplinary Committees and/or Utilization Management Committee. Develops and implements interdisciplinary… more
    Saratoga Hospital (06/26/25)
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  • Health Insur & Auth Rep III

    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 (05/29/25)
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  • Care Management Representative

    Saratoga Hospital (Saratoga Springs, NY)
    Care Management Representative Location: Saratoga Hospital, 211 Church Street, Saratoga Springs, NY 12866 Shift/Schedule: Day Shift Department: Care ... Groups under the guidance of the Director of Care Management . The Care Management Representative ...the hospital and its goals of rendering quality care management services . Is a critical thinker and… more
    Saratoga Hospital (07/02/25)
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  • Care Management Representative…

    Saratoga Hospital (Saratoga Springs, NY)
    …and strategic plans for specific Collaborative Practice Groups. The Care Management Representative participates in a collaborative process which assesses, ... and mission of the hospital and its goals of rendering quality care management services . Is a critical thinker, problem-solver, and proficient communicator with… more
    Saratoga Hospital (06/17/25)
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  • Case Manager (Inpatient Units)

    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
    Ellis Medicine (06/12/25)
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  • Pharmacy Resident II/ PGY-II; HSO Pharmacy; Mount…

    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
    Mount Sinai Health System (04/16/25)
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  • Guest Services Rep III

    University of Rochester (Rochester, NY)
    …Time Type: Part time Scheduled Weekly Hours: 20 Department: 500059 Ambassador and Guest Services Work Shift: UR - Day (United States of America) Range: UR URCB 203 ... **Responsibilities:** GENERAL PURPOSE: With general direction of the Ambassador Management Team and with latitude for independent initiative and judgment:… more
    University of Rochester (06/06/25)
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  • Clinical Manager School Based

    Hillside Family of Agencies (Rochester, NY)
    …of the day-to-day operations of the program, including hiring, training, fiscal management , utilization management , clinical oversight and regulatory ... SUMMARY The Clinical Manager ensures the delivery of quality services to youth and their families by providing guidance...within budget parameters. + Ensures program consistently achieves budgeted utilization and works with team to address any … more
    Hillside Family of Agencies (06/21/25)
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  • Manager Intake Specialists

    Hillside Family of Agencies (Rochester, NY)
    …communicated effectively to meet agency and regulatory requirements. + Facilitate Agency Utilization Management meetings to ensure residential youth continue to ... needs, utilization trends, and opportunities for improvement of existing services as well as determining opportunities to serve targeted populations. + Ensure… more
    Hillside Family of Agencies (07/08/25)
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