- Stony Brook University (Stony Brook, NY)
- …the use of UHIS (Cerner) and LIS (Clinisys & CoPath) order entry and result review screens, new tests additions to the test menu, upgrades to current systems, and ... assigned. + Responsible for daily and monthly monitoring (including documenting monthly review ) of the Rees Temperature Monitoring System for Immunology or Flow… more
- 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
- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… 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
- Molina Healthcare (Albany, NY)
- …unit or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- SUNY Upstate Medical University (Syracuse, NY)
- …Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, experience with ... contracts with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients… more
- Molina Healthcare (Albany, NY)
- …be licensed for the state they reside This role will be doing Utilization review for our Ohio Medicaid population, looking for clinicians with strong ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Guthrie (Binghamton, NY)
- …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care...or position and b) Demonstrated leadership skills for a licensed degree exception, there must be a significant depth… more
- Mohawk Valley Health System (Utica, NY)
- …population. Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member ... - SNH is responsible for the oversight of the case management staff's authorization/coordination/ utilization and provision of member services. Duties include… more
- Centene Corporation (New York, NY)
- …New York + Board certified in Internal Medicine or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- DePaul (Rochester, NY)
- …the Quality Management Plan within the corporation. + Incident Management - review incident reports and provide feedback and recommendations(site-specific). ... trends for reporting and follow-up consultation and training. + Responsible for Utilization Record Review functions to include Individual record audits,… more
- New York State Civil Service (Albany, NY)
- …mental illness in a clinical capacity, as well as experience with utilization management and/or utilization review . ? The ideal candidate(s) will have ... all community based mental health services funded, designated and/or licensed by OMH that serve children and their families,...direct care and utilization management experience, including familiarity with the review … more
