Utilization management jobs in Richmond Hill, NYCreate job alerts

Utilization Management Specialist MSH Case Management FT Days. Position responsibilities will include utilization management support functions for patient admissions and continuing stay. This position also facilitates and tracks concurrent adverse determinations and collaborates with Appeals Mana...

Supervise the management of the Denial Management System of the Utilization Management Department. Coordinate and ensure that, on a timely basis, all staff of the Utilization Management Department complete their Online or In-Person Annual In-Service Training and other mandated training for NYC He...

The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members. Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not...

Assists all departments with the resolution of members' problems related to utilization management issues. MetroPlusHealth Utilization Management policies, procedures, and protocols. Informs member and provider of Utilization Management determinations and treatment alternatives.

For Utilization Management Only:. Ensures all records/logs related to decision requests, Notices of Action, and other communications required by state or federal regulations are saved in the Utilization Management System. Coordinates with management, subject matter experts, physicians, member rep...

MetroPlusHealth Utilization Management policies, procedures, and protocols. Informs member and provider of Utilization Management determinations and treatment alternatives. Assists all departments with the resolution of members' problems related to utilization management issues.

Informs member and provider of Utilization Management determinations and treatment alternatives. Performs all Utilization Management activities in compliance with all regulatory agency requirements. MetroPlusHealth Utilization Management policies, procedures, and protocols.

We're hiring a Senior Analyst, Utilization Management to join our Strategic Planning team. The Senior Analyst, Strategic Planning supports developing and executing on strategies to achieve team or larger organization targets. The Senior Analyst, Strategic Planning has a strong focus on using data...

You’ve spun your compass and landed here! A facility in Bronx, NY, is currently hiring a RN (Registered Nurse) to work in Case Management (Utilization Review).

The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members. The Care Manager under the direction of the Vice President of Clinical Services, is primarily responsible for man...

The Case Management Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilizatio...

The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members. The Care Manager under the direction of the Vice President of Clinical Services, is primarily responsible for man...

Precertification: Utilization Management Nurse Consultant - SCPU.

Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Nurse Medical Management II - Utilization Management. Ensures medically appropriate, high quality, cost effective care through as...

As a new Director of Utilization Management at VillageCare, you can expect to oversee the utilization review process, collaborate with interdisciplinary teams to optimize patient care, and develop strategies to enhance operational efficiency. Would you be a great Director of Utilization Managemen...

Train finance staff in proper utilization of the automated financial management system. * Provide ad hoc support to the financial management system team. Applied Knowledge & Skills: * Strong critical ...

Prepare reports and statistical information for both CAMBA management and funder use. * Assist in ... Ensure staff utilization of electronic database and conduct oversight to ensure data integrity

Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization ...

Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing. Job Description

Utilization Management * Participate in utilization review and management. * Maintain focus on key strategic priorities including patient experience, access to care, increased market share, and ...

Complete Readmission screen in the Care Management Module (CarePort). * Conduct Utilization review via Chart Review. * Conduct timely concurrent reviews and responses to third party payors request ...

We offer top paying assignments from Summit Medical Staffing. Compare your offer with the market to maximize compensation. Chat anonymously with recruiters & submit a universal application w/ 1 click.

Registered Nurse - Pediatric Case Manager. Nurses with experience in any of the following areas are ... Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and ...

Experience with Care Coordination, Utilization review and discharge planning Computer literacy ... Master's Degree and Bilingual Spanish Certification in Case Management preferred. BLS-AHA #HCRR RS ...