- Molina Healthcare (Syracuse, NY)
- **Job Description** Job Summary Creates and delivers clinical training programs for clinical staff across the enterprise to orient employees to Molina ... clinical methodology, along with policies, processes and systems. Ensures...the development, implementation, and delivery of training curriculum for Utilization Management, Case Management, and LTSS staff. Leads and… more
- STG International (Auburn, NY)
- …patient safety. + Participate in quality improvement, care management, risk management, peer review , utilization review , clinical outcomes, and health ... Performance Improvement Team (QPIT) strategic initiatives. + Participate in review and improvement of clinical success in...+ Participate in review and improvement of clinical success in of areas of responsibility. + Adhere/monitor… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending...guidance and leadership to the daily activities of the Utilization Management Department clinical staff. Acts as… more
- Helio Health Inc. (Syracuse, NY)
- …referring to the medical provider those that require additional expertise. + Review clinical information for concurrent reviews, extending the length of ... preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care setting. +… more
- Crouse Hospital (Syracuse, NY)
- …while maintaining the quality of care. + Demonstrates proficiency with standard Utilization Review processes. + Responsible for concurrent and continued stay ... and outreach programs. Crouse's Care Coordination Services team is hiring a Utilization Management Registered Nurse (RN) to track and manage data and client… more
- Molina Healthcare (Syracuse, NY)
- …& ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical… more
- Molina Healthcare (Syracuse, NY)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Molina Healthcare (Syracuse, NY)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- CenterWell (Liverpool, NY)
- … of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... on-site at our Liverpool, NY branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Molina Healthcare (Syracuse, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Hearings as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical...+ Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals.… more
- Trinity Health (Syracuse, NY)
- …day-to-day operations of the Unified Enterprise Ministry's (UEM) Trinity Health Clinical Engineering (THCE) program at Regional Health Ministry (RHM) Hospital and ... objectives, and strategies. Oversees the day-to-day management of the RHM's clinical engineering program and ensures program service support objectives are met.… more
- Molina Healthcare (Syracuse, NY)
- …LMHC) * Minimum of 6 years' experience in health care * Understanding of clinical operations: utilization management, case management, etc. * Ability to provide ... with internet connectivity of high speed required. **Job Summary** The Sr. Clinical Performance Consultant is responsible for the successful execution of clinical… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …accreditation standards pertaining to its state licensure, third party administrators, utilization review and management requirements. The Manager of Compliance ... policy and procedure. Responsible for the overall management of the clinical team and corresponding policy, procedure, and programs. **Job Summary:** Reporting… more
- Molina Healthcare (Syracuse, NY)
- …include those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- Molina Healthcare (Syracuse, NY)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Required MD licenses in the following states: **AZ, WA,** FL, ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Molina Healthcare (Syracuse, NY)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... at the right place at the right time and assisting them to achieve optimal clinical , financial, and quality of life outcomes. + Responsible for clinical teams… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review /Quality Assurance Sr. Coordinator will be responsible for providing clinical information to managed care companies as ... agencies, and other health care related entities. Preferred Qualifications: Utilization Review /Managed Care/Quality Assurance experience. Experience in the… more
- Molina Healthcare (Syracuse, NY)
- …management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy ... delegated by the Manager. + Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization , and adherence. **JOB… more
- Molina Healthcare (Syracuse, NY)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . * Incorporate leadership and communication skills to work ... broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility based services. +… more
- Molina Healthcare (North Syracuse, NY)
- …the community and accessing and using durable medical equipment (DME). * Experience in utilization review , concurrent review and/or risk management a plus. * ... corrections and revision of CHA paperwork and tasking tool documentation based on review and feedback provided through quality and associated review process.… more