- CVS Health (Albany, NY)
- … clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- CVS Health (Albany, NY)
- …with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Management opportunity for RNs with a **New York** state licensure. ... with active and unrestricted New York state licensure + 1+ year of Utilization review experience + 1+ year of clinical experience **Preferred Qualifications**… more
- Guidehouse (New York, NY)
- …efficiency, quality, and reliability. Areas of expertise include care and utilization management , throughput, post-acute care and readmissions, pharmacy and ... and operational improvement across business and purchased services, supply cost, and clinical supply utilization at client provider organizations. Our team of… more
- Guidehouse (New York, NY)
- …efficiency, quality, and reliability. Areas of expertise include care and utilization management , throughput, post-acute care and readmissions, pharmacy and ... and operational improvement across business and purchased services, supply cost, and clinical supply utilization at client provider organizations. Our team of… more
- CVS Health (Albany, NY)
- …+ Human Resource and/or Supervisory experience. + Case management , Utilization Review, or Utilization Management background preferred. **Education** ... Friday, 11:00 am to 8:00 pm Eastern Time.** The Consultant provides management consultation to corporate clients...clinical assessments and triage into care. Performs case management across scope of all types of management… more
- Boehringer Ingelheim (White Plains, NY)
- **Description** The Cardiovascular-Renal Sales Consultant is responsible for partnering in developing and implementing a plan for brand sales growth of BIPI and ... and with BIPI guidelines, policies, and directives. The Cardiovascular-Renal Sales Consultant will conduct their business with key targeted healthcare providers… more
- Highmark Health (Albany, NY)
- …needs and the analytical technology team. The Senior Decision Support Consultant will leverage technical, analytical, and business expertise to design, develop, ... while also being capable of developing technical solutions. The consultant will act as a senior resource within the...the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The… more
- Highmark Health (Buffalo, NY)
- …set by the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for ... enrolled in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected… more
- UHS (Vestal, NY)
- …ensure the highest standards of patient care through effective resource coordination and utilization . In this role, you'll collaborate with clinical teams to ... of Clinical Operations and collaboratively with UHS Nursing, Quality Management , Risk Management , Performance Improvement, and other system members to… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …to its state licensure, third party administrators, utilization review and management requirements. The Manager of Compliance and Clinical Operations will ... maintenance of all HealthDirect policy and procedure. Responsible for the overall management of the clinical team and corresponding policy, procedure, and… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …benefits and State and Federal Mandates and maintains current and working knowledge of Utilization Management Standards. + Clinical skills are excellent and ... area including, but not limited to, Medical and Pharmacy Utilization Management , quality management , member...at first level, appeal and inquiries. + Conducts peer-to-peer clinical reviews with attending physicians or other providers to… more
- Albany Medical Center (Albany, NY)
- …works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to ... achieve maximum clinical and financial outcomes. The Case Manager participates in...assigned service - required + Recent experience in case management , utilization management and/or discharge… more
- Bassett Healthcare (Cooperstown, NY)
- …healthcare team to improve LOS performance of the Bassett Healthcare Network. This clinical position works in conjunction with the physician and/or staff and has the ... bed allocation resources to determine placement based on medical needs. + Clinical and Technical Responsibilities. + Provides centralized one-call service for direct… more
- FLACRA (Penn Yan, NY)
- …progress notes and other documentation required for the client medical record and utilization management within the timelines outlined by FLACRA. + Participates ... senior clinician is a clinician with demonstrated leadership skills and clinical excellence with experience in substance abuse and mental health treatment.… more
- Catholic Health Services (West Islip, NY)
- …hospital care management leadership role is required. + Experience in utilization management , working with managed care organizations, and discharge planning ... : + Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management , CH Utilization and Central Appeals, Managed Care and Revenue Cycle… more
- Ellis Medicine (Schenectady, NY)
- …Services discharge planning guidelines and departmental/organizational policies and processes + Utilization Management : + Ensures order in chart/EMR coincides ... the Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration...of care with Social Worker + Serves as nurse consultant for Social Worker cases with Clinical … more
- Trinity Health (Syracuse, NY)
- …Nurse Coordinator is a dynamic leadership role that contributes to the operational management of the unit to promote and support an environment of excellent patient ... interdisciplinary team including ortho, bariatric & neurosurgery physicians & clinical affiliates, rehab services, pharmacy and nutritional services. +… more
- Trinity Health (Syracuse, NY)
- …patient record. + Act as 1) mentor; 2) clinician; 3) educator; 4) consultant /collaborator; and 5) navigator. **Career Path:** + Clinical ladder advancement with ... Nurse Supervisor is a dynamic leadership role that contributes to the operational management of the unit to promote and support an environment of excellent patient… more
- Guthrie (Binghamton, NY)
- …communication skills. B. Serves as an advocate for patients and family in the clinical management of care. Confers with leadership team and professional staff to ... decision‐making, accountability and autonomy in nursing practice. D. Acts as a consultant regarding clinical , administrative or legal aspects of patient care.… more
- WMCHealth (Kingston, NY)
- …Nursing and/or other staff as needed in the performance of procedures. CLINICAL MANAGEMENT + Monitors the department QC/QA program. Ensures completion ... The Lead Techologist provides direction to Nuclear Medicine staff. RESPONSIBILITIES CLINICAL EXPERTISE + Competently operates all units of the sections imaging… more