- Hackensack Meridian Health (Hackensack, NJ)
- The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Hackensack University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Hackensack Meridian Health (Hackensack, NJ)
- **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of ... population and Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Exciting Opportunity for OR-Experienced Physician Assistants!** Join The Mount Sinai Hospital and become an operational leader. Gain hands-on ... with this incredible opportunity! The Program Director is a credentialed Physician Assistant (PA), responsible for daily operations of _all_ surgical sub-specialties… more
- Centene Corporation (New York, NY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager ... are not limited to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Mount Sinai Health System (New York, NY)
- …interprets the clients responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than ... to established standards as part of initial orientation and annual performance review with collaborating physician or appropriately credentialed designee. +… more
- Mount Sinai Health System (New York, NY)
- …interprets the clients responses to the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion but not less than ... to established standards as part of initial orientation and annual performance review with collaborating physician or appropriately credentialed designee. 4.… more
- Mount Sinai Health System (New York, NY)
- …Masters preferred. + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... are not limited to: 1. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Elevance Health (New York, NY)
- …+ Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate on committees or in ... decisions to members and providers. **How you will make an impact:** + Perform physician -level case review , following initial nurse review , of Medical… more
- Molina Healthcare (Yonkers, NY)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- WMCHealth (Valhalla, NY)
- …of quality and cost improvement that is data driven and develops systems to review utilization of resources and measure outcomes of care. Monitors physician ... in association with the DIO of NYMC + Reviews utilization of hospital clinical resources and provides guidance when...interpretation of trends to physicians and hospital committees for review . + Assures that quality management programs are carried… more
- WMCHealth (Valhalla, NY)
- …the results. + Maintains familiarity with the laws, regulations, and interpretation of utilization review and discharge planning. Remains up to date on changes ... Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: Clinical… more
- Mount Sinai Health System (New York, NY)
- …interprets the client's responses to the plan of care. 11. Performs a patient record review with the collaborating physician in a timely fashion but not less ... to established standards as part of initial orientation and annual performance review with collaborating physician or appropriately credentialed designee. 4.… more
- Northwell Health (Mount Kisco, NY)
- …RN Case Management and Social Work Services team. Develops processes to monitor utilization review inclusive of length of stay (LOS) and resource reduction ... facility best practices and makes recommendations for process improvement. Oversees resource utilization for the hospital and provides specific data analysis on … more
- BronxCare Health System (Bronx, NY)
- …electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible ... the department's leadership develop strategies for denial prevention, improved utilization management, documentation of medical necessity and identify patterns and… more
- Mount Sinai Health System (New York, NY)
- …The Clinical Program Manager, Clinical Command Center is a Registered Professional Nurse, Physician Assistant, or Nurse Practitioner, who manages the 24 hour a day ... patient-centered care. **Qualifications** Must be a Licensed Registered Nurse, Physician Assistant or Nurse Practitioner Registered Nurse Bachelor?s Degree in… more
- Elevance Health (New York, NY)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician -level case review of utilization requests for procedures ... case reviews for their board certified specialty. + Makes physician to physician calls to gather medical...decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review … more
- Deloitte (New York, NY)
- …physician , physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and health IT ... tools as necessary for physicians, CDI team and ancillary staff and assist physician champion to conduct education as needed + Train CDI team, physicians and… more
- Project Renewal, Inc. (New York, NY)
- …in the development and implementation of quality assurance management and utilization review + Participates in interdisciplinary meetings with shelter ... Title: Primary Care Physician - Part Time Program: Healthcare Department ,...$120,000 depending on experience Position Overview: The Primary Care Physician working in Mobile Health is responsible for the… more
- WMCHealth (Hawthorne, NY)
- …AR, payor mix, billing throughput and other performance statistics. + Physician and Mid-level provider productivity, utilization , patient referrals, ... software systems and data filing systems and processes. + Prepare and review budget, revenue, expense, payroll entries, invoices and other accounting documents. +… more