- BronxCare Health System (Bronx, NY)
- …Management Position Type Regular Full-Time Division Bronxcare- Yonkers Max USD $97,125.00/Yr. Shift Day Shift Department : Name Appeals Department (BHCS) ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
- VNS Health (Manhattan, NY)
- …the day to day management of clinical appeals review processes within Appeals & Grievances Department . + Manages the intake, investigation and resolution of ... of members experience with A&G. + Tracks grievances and appeals that are in process in the department...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …determinations - OBS vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based Appeals Management e. ... documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate...e. Provides professional support to the functions within the Utilization Management Department f. Provides periodic written… more
- Mount Sinai Health System (New York, NY)
- …to insure patient admission is approved Identifies and refers to the UM Manager &/or Administrator and/or Physician problematic utilization and quality issues ... Responsible for the maintenance of accurate data for approvals, denials and appeals (in coordination with UM Manager and management). Prioritizes insurance… 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** The Case Manager (CM) will be responsible for all aspects...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… 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 FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Case Manager is responsible for all aspects of case management/ utilization review for an assigned group of inpatients, ED patients and ... basis and identify the expected length of stay (ELOS). The case manager works collaboratively with physicians, social workers, clinical nurses, home care services,… more
- VNS Health (Manhattan, NY)
- …+ Engages in and contributes to the interdisciplinary team's utilization management activities and recommended interventions for members/participants. Establish ... and implementation of the behavioral health sections of the Quality Management (QM)/ Utilization Management (UM) Plan. Oversees the administration of all BH QM/UM and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …ortho calls, payer communications and support of the Care Coordinators. Prepares required Appeals and Denial information for processing and follows up on receipt of ... Oversees the sorting and distribution of mail in the department . Answers case management and social work phones. Medicaid...of free text fields, to support the case management, utilization review process. + Retrieves information for the Physician… more
- CUNY (New York, NY)
- …of the Registrar. . Analyzes data, delegates assignments to ensure maximum utilization of capacities of staff, support in the development and implementation of ... directed by the Registrar. . Represents the Registrar at key meetings with Deans, Department Chairs and acts on his/her behalf as directed. . Under the direction of… more