- Elevance Health (Latham, NY)
- The ** Licensed Utilization Review I** is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan ... diploma or equivalent and a minimum of 2 years of clinical or utilization review experience; or any combination of education and experience, which would provide… more
- CDPHP (Albany, NY)
- …who share these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and ... reviews for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and inpatient… more
- Staffing Solutions Organization (Albany, NY)
- …(Item 1416) in Albany, NY** **Day-to-Day Tasks of Position:** Oversee the Medicaid Drug Utilization Review Program and Drug Utilization Review Board ... Licensed NYS Pharmacist - DPDM One Commerce Plaza,...the review and Prioritize and oversee Drug Utilization Review (DUR) Board activities, including the… more
- Highmark Health (Albany, NY)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Trinity Health (Albany, NY)
- …the clinically required placement, services and/or equipment needed. Supports the licensed staff by completing concrete tasks necessary to facilitate the seamless ... most complex of transitional care plans in tandem with licensed staff. This position is responsible for assisting in...discharge plan. + Collaborate with clinical care teams to review for medical necessity and medical appropriateness of mental… more
- CVS Health (Albany, NY)
- …managed care (Medicare and/or Medicaid) Experience with managed care (Medicare and Medicaid) utilization review preferred MD or DO; Board certification in an ... and consistent responses to members and providers related to precertification, concurrent review , and appeal request. The medical director is a work-at-home position… more
- New York State Civil Service (Rensselaer, NY)
- …research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or ... and/or day program, under the supervision of a doctoral level psychologist, licensed psychologist, licensed physician, licensed psychiatrist, psychiatric… more
- New York State Civil Service (Schenectady, NY)
- …the Associate Budget Analyst, will perform duties related to space utilization ; office equipment selection and maintenance; property management; building health and ... include, but are not limited to, the following:* Maintain records, and review and reconcile expenses related to leases, utilities, building and equipment maintenance… more
- Trinity Health (Albany, NY)
- …Skilled Nursing Facilities have a unique opportunity for a RN to receive, review and process referrals of patients at St. Peter's Hospital referred for subacute ... members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources. + Screening of clients… more
- Veterans Affairs, Veterans Health Administration (Albany, NY)
- …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA Albany Healthcare System's mission is ... for providing competent, evidence-based care to patients with oversight of licensed vocational nurses/nursing assistants as appropriate to the setting. The nurse… more
- Ellis Medicine (Schenectady, NY)
- …Ensure the accuracy and appropriateness of all prescriptions filled by completing Drug Utilization Review and Final Quality Assurance, applicable to state and ... Science degree in Pharmacy or a Doctor of Pharmacy degree + Must be licensed to practice in New York State and possess Immunization Certification through an… more