- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our ... management of clinical appeals review processes within Appeals & Grievances Department . + Manages the...Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and… more
- Molina Healthcare (Yonkers, NY)
- …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical...has been made or upon request by another Molina department to reduce the likelihood of a formal appeal… 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 e. Target DRGs Reviews f. Use of case manager as a resource + Uses guidelines to evaluate...e. Provides professional support to the functions within the Utilization Management Department f. Provides periodic written… 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
- Hackensack Meridian Health (North Bergen, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains ... healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for… 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
- CBRE (New York, NY)
- VAS - Funds Manager Job ID 197535 Posted 04-Feb-2025 Service line Advisory Segment Role type Full-time Areas of Interest Valuations/Appraisal Location(s) Atlanta - ... - United States of America **About The Role:** As a CBRE Valuation Funds Manager , you will independently prepare market value appraisals on real estate assets with… more
- Molina Healthcare (Yonkers, NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Lead Pharmacist, Utilization Management (UM) will serve as a team lead...serve as a team lead to support the pharmacy manager in the daily operations of the pharmacy team… more
- MTA (New York, NY)
- …Unit: MTA Headquarters Location: New York, NY, United States Regular/Temporary: Regular Department : Labor Relations MNR Date Posted: Mar 17, 2025 Description POSTING ... effective and timely processing of investigations, pre-trial conferences, trials, union appeals and assists with answering grievances. The position is charged with… more