- 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
- 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
- Molina Healthcare (Rochester, 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
- 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
- Veterans Affairs, Veterans Health Administration (Canandaigua, NY)
- …track service activities including visits, referrals, caregiver demographics, equipment utilization and caregiver and Veteran satisfaction. Develops implements and ... evaluates clinical guidelines and protocols to establish appropriate utilization of services. Participates in direct caregiver and Veteran communication to identify… more
- MVP Health Care (Rochester, NY)
- …Workplace** . The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. ... health needs. **Qualifications you'll bring:** + Master's prepared and licensed mental health clinician (LMSW, LCSW, LMHC, etc.) or...with at least 2 years being ASD related + Utilization or Case Management experience in a… more
- Rochester Regional Health (Rochester, NY)
- …in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay reviews ... efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other… more
- MVP Health Care (Rochester, NY)
- …senior leaders to promote appropriate care quality, service utilization , medication utilization and adherence, care management , and cost control. + Through ... and an **Inclusive Workplace** . **Qualifications you'll bring:** + Licensed to practice medicine in New York State. +...of NYS child serving systems. + Experience with critical review in clinical scenarios is desirable. + Knowledge of… more
- Rochester Regional Health (Rochester, NY)
- …+ Practices according to Agency and community standards + Participates in utilization review and/or continuous quality improvement activities as requested. + ... as indicated + Supervises and evaluates care provided by Licensed Practical Nurses and/or home health aides in the...required. + Performs other job-related duties as assigned by management . LEVEL II: + Offers process improvement suggestions and… more
- University of Rochester (Rochester, NY)
- …requests, and external oversight: ie) NYS DOH, ACS Committee on Trauma Registry Management : + Monitor security of data to ensure the integrity and reliability of ... Attend registry vendor sponsored training workshops/meetings to maximize trauma registry utilization and performance. Registry Admin Duties + Oversee the conversion,… more
- Molina Healthcare (Rochester, NY)
- …member care. **Essential Job Duties** * Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved ... in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. *… more