- Molina Healthcare (Rochester, NY)
- …authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate ... clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance… more
- Molina Healthcare (Rochester, NY)
- …authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate ... clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address member ... for additional hours. Essential Accountabilities: Level I + Performs pre-service, concurrent and post-service clinical reviews to determine the appropriateness of… more