- 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
- 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
- LiDestri (Rochester, NY)
- …and resolve any and all issues related to product quality, pricing, delivery, utilization and loss. Complete all ordering in a timely manner and within budget. ... + Meet with vendors to review performance. + Processes orders, checks on status of...and other metrics and prepare reports of findings to management , as required. + Works with department manager to… 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