- 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
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible… more
- 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 ... 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
- 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
- Albany Medical Center (Albany, NY)
- …proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to ... service . Acute care nursing experience preferred.4. Recent experience in case management , utilization management and/or discharge planning/home care in a… more
- 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
- 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
- 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
- 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
- University of Rochester (Rochester, NY)
- …arranges for admission of patients to inpatient and outpatient beds and services , schedules and assigns accommodations or service locations; determines financial ... internal equity considerations._ **Responsibilities:** GENERAL SUMMARY Using excellent customer service skills and exercising thorough knowledge of hospital policy… more
- Molina Healthcare (New York, 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
- University of Rochester (Rochester, NY)
- …when needed. Maintains and updates cancellation/wait lists to effectively manage utilization . Answers phones, triages calls and relays messages. Fields patient ... independently. Maintains and updates cancellation/wait lists to effectively manage utilization . Ensuring clinics are appropriately full and operating efficiently.… more
- University of Rochester (Rochester, NY)
- …on more complex assignments. **ESSENTIAL FUNCTIONS** + Interprets eligibility for admission/ service /treatment plans. + Documents in a timely, accurate manner in the ... urgent admissions. + Marks patients for merge and notifies Health Information Management . + Exercising tact, initiative and independent judgment based on financial… more
- University of Rochester (Rochester, NY)
- …**Responsibilities:** GENERAL PURPOSE: Performs the functions of patient account management for individuals receiving services . Completes the tasks ... requesting deposits, initiating referrals to sponsorship programs. Coordinates account management through discharge and forwards accounts to the patient accounting… more
- MTA (Brooklyn, NY)
- …acquires a solid foundation, knowledge, and/or experience in the areas of utilization management , quality improvement, and employee fitness for duty ... Brooklyn, NY, United States Regular/Temporary: Regular Department: Occupational Health Services Date Posted: Apr 30, 2025 Description JOB TITLE: Administrative… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …with CDPAS documentation and authorizations. PRIMARY RESPONSIBILITIES: + Point person for Utilization Management , Case Management and G&A regarding ... a change in provider + Communicate with current provider regarding stabilizing services + Communicate with providers regarding staffing new cases + Assist delegating… more
- Phoenix House (Wainscott, NY)
- …Up to 25% **Job Shift** Morning **Job Category** Nonprofit - Social Services **Description** **SUMMARY** The Utilization Review (UR) Manager coordinates ... ** Utilization Review Manager** **Job Details** **Job Location** East...Care benefits and approvals for patients receiving behavioral health services . The Manager will monitor claims and approvals to… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in completing authorization updates… more
- Datavant (Albany, NY)
- …and services with a high-level understanding of Health Information Management (HIM), Release of Information (ROI), Payer-Provider data exchange, revenue cycle ... accounts. + Provide suggestions for new sales opportunities regarding our software, services , or marketing approach to appropriate management staff. + Provide… more