- 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 ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Molina Healthcare (Rochester, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS… more
- FLACRA (Penn Yan, NY)
- …within the timelines outlined by FLACRA. + Participates in quality initiatives and utilization review activities as requested. + Strives to understand and meet ... Integrated Outpatient Senior Clinician FLACRA Penn Yan, NY (Onsite) Full-Time $34.00/Hour...staff and community service providers. + Knowledge of local behavioral health service system. + Ability to multi-task, have… more
- Highmark Health (Albany, NY)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Garnet Health (Harris, NY)
- …Case Manager for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. Join the Garnet Health team and ... your career home with us as a Social Worker on our Inpatient Behavioral Health Unit (BHU) team at/in Garnet Health Medical Center-Catskill. Responsibilities The… more
- MVP Health Care (Tarrytown, NY)
- …difference for our customers in every interaction **Your key responsibilities:** + Review all requests for behavioral health services utilizing the appropriate ... improvement. To achieve this, we're looking for a **Professional, Behavioral Health** to join #TeamMVP. If you have a...you'll bring:** + Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or Licensed Registered Nurse… more
- New York State Civil Service (NY)
- …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... under the supervision of a licensed psychologist or other appropriate licensed clinician ; * Develop and write behavioral /treatment plans and complete functional… more
- University of Rochester (Brighton, NY)
- …billing and data reporting. Work with Strong Ties leadership and Dept of Psychiatry Utilization Review team to address documentations concerns in a timely way ... who interact with the most challenging and vulnerable patient population in Behavioral Health clinical services. The Clinical Coordinator is also an integral member… more