- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required. +… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors ... advisors and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with all insurance and regulatory… more
- Elevance Health (New York, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** This role enables associates to work...Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements… more
- Molina Healthcare (Yonkers, NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Molina Healthcare (Yonkers, NY)
- …expert. * Ensures Molina is compliant with the coverage determination and appeals process. * Contributes to projects aimed at improving STAR ratings, Healthcare ... initiatives under the direction of leadership. * Monitors drug utilization and assists leadership team in understanding quality and...care team (ICT). * Works with the Pharmacy Benefit Manager (PBM) to manage formulary changes and update marketing… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years experience as a ... **Job Description** **RN/Case Manager MSH Case Management PT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- CUNY (Brooklyn, NY)
- …early intervention student support service process, the resolution of student grievances, appeals , and complaints, and the utilization of the Behavioral ... Manager of Student Advocacy and Accountability (HEA) **POSITION...conduct reports; coordinating the student conduct process, grievances, and appeals . + Oversee the Faculty Student Disciplinary Committee to… more
- Elevance Health (New Hyde Park, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Manager , Medical Director - Transformation Initiatives** Location: This...of Care / Payment Integrity** + **Care Management / Utilization Management (CM/UM) Modernization** + **Provider Networking & Modernization**… more
- Amgen (New York, NY)
- …us and transform the lives of patients while transforming your career. **Field Reimbursement Manager - New York Metro** **What you will do** Let's do this. Let's ... change the world. In this vital role the Field Reimbursement Manager (FRM) will manage defined accounts within a specified geographic region for Patient Access and… more
- City of New York (New York, NY)
- …hearings by mail, web, and mobile app. In addition, the judges hear appeals of parking ticket determinations, and a special unit for Commercial Adjudications ... conducts hearings and appeals on tickets issued to commercial vehicles. The Customer...Analyst (Non-Managerial Level 2) to serve as the Operations Manager for the STARS Modernization Project. The selected candidate… more
- Molina Healthcare (Yonkers, NY)
- … Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. + ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more
- Molina Healthcare (Yonkers, NY)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Catholic Health Services (West Islip, NY)
- …Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and ... Hospital Conditions of Participation. + Implements care management programs, including utilization review, intake and discharge planning. + Evaluates patient care… more
- Elevance Health (New York, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... not required for posting. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical program and/or independently… more
- Elevance Health (New York, NY)
- …for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of company ... Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions listed above. + Conduct… more