- 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
- 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
- University of Rochester (Rochester, NY)
- …Time Type: Part time Scheduled Weekly Hours: 24 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 (Rochester, NY)
- …Time Type: Full time Scheduled Weekly Hours: 40 Department: 500059 Ambassador and Guest Services Work Shift: Range: UR URCB 203 H Compensation Range: $18.00 - $23.81 ... assigned. Responsibilities Position Summary With general direction of the Ambassador Management Team and with latitude for independent initiative and judgment:… more
- University of Rochester (Rochester, NY)
- …/ Per Diem Scheduled Weekly Hours: As Scheduled Department: 500059 Ambassador and Guest Services Work Shift: Range: UR URCB 203 H Compensation Range: $18.00 - $23.81 ... and various other duties as assigned. With general direction of the Ambassador Management Team and with latitude for independent initiative and judgment: Serves as a… 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
- 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
- MVP Health Care (Plattsburgh, NY)
- …interdepartmental collaboration with key stakeholders from departments such as Operations, Utilization Management , Quality and Member Appeals to resolve provider ... Professional, Provider Relations Representative Plattsburgh, NY, USA * Vermont, USA Req...in health insurance or equivalent experience in Finance, Relationship Management , Contract Management or equivalent provider office… 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
- 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
- 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
- Casella Waste Systems Inc. (Geneva, NY)
- ## Position Summary The Commercial Service Representative provides one\-stop service and solutions to new and existing customers by determining service ... and implements analytical data reports to track inventory, customer utilization , service fulfillment, overdue service ...or more technical areas of Casella's business and customer service and client relationship management \. Able to… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Member Service Representative shall assume full responsibility and ownership for all aspects ... complaints, and advise the customer of their rights and responsibilities. The Member Service Representative will work closely with all departments, such as… more