- 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
- Trinity Health (Syracuse, NY)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** The RN Utilization Management Nurse Coordinator is responsible for both concurrent and ... retrospective inpatient and outpatient services, in accordance with the utilization requirements and 3rd party payor contracts. The UM...in the UMCC department, gather and renew denial metrics, review and evaluate LOS O/E metrics for trends and… 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)
- …management (such as, reviewing prior authorization requirements, 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… more
- Molina Healthcare (Syracuse, NY)
- …management (such as, reviewing prior authorization requirements, 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… more
- Molina Healthcare (Syracuse, NY)
- …compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical ... in consistent and efficient manner. + Makes appropriate referrals to other clinical programs. + Collaborates with multidisciplinary teams to promote Molina Care… more
- Trinity Health (Syracuse, NY)
- …12-day shifts. Emergency department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) ... actively manages the utilization review process and patient progression from Admission to Discharge....works collaboratively with unit staff and support team (RN, Physician/ Clinical Affiliate, DPA, MSW, CDI, Rehab Services, etc.) to… more
- Molina Healthcare (Syracuse, NY)
- …as well as a Bachelor's Degree_ **JOB DESCRIPTION** **Job Summary** The mission of Clinical Operations is to drive value through an integrated Clinical Center of ... service. To achieve this objective, this role will support a specific Clinical Center of Excellence in establishing best practices and driving standardization and… more
- Fresenius Medical Center (Camillus, NY)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Molina Healthcare (Syracuse, NY)
- …state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… 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)
- …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
- Crouse Hospital (Syracuse, NY)
- …related to acute care discharge planning. + Preferred: + Acute care utilization review experience. + Previous leadership experience. + SPECIAL SKILLS/EQUIPMENT ... achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to...+ Working knowledge of MS Office. Expert knowledge of clinical review criteria such as InterQual, Milliman… more
- Elevance Health (East Syracuse, NY)
- …+ Responsibilities exclude conducting any utilization or medical management review activities that require the interpretation of clinical information. + ... and multiple products, (Part A & B) related to clinical and non- clinical services, quality of service,...response in clear, understandable language. + Utilizes guidelines and review tools to conduct extensive research and analyze the… more
- Molina Healthcare (Syracuse, NY)
- …managed care or medical or behavioral health settings. + One year of auditing/ clinical review experience. + More than one-year supervisory experience. To all ... + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT),… more
- Molina Healthcare (Syracuse, NY)
- …an actively licensed Registered Nurse_ **JOB DESCRIPTION** **Job Summary** The mission of Clinical Operations is to drive value through an integrated Clinical ... service. To achieve this objective, this role will support a specific Clinical Center of Excellence in establishing best practices and driving standardization and… more
- Molina Healthcare (Syracuse, NY)
- …management (such as, reviewing prior authorization requirements, 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… more
- Crouse Hospital (Syracuse, NY)
- …programs. Crouse's Care Coordination Services team is hiring a Care Manager to review the services delivered to patients and compare to evidence-based guidelines in ... maintaining the quality of care. + Participates in the utilization management process using standards of care to determine...assessment of the patient's discharge plan based on the clinical course and proactively interacts with the healthcare team… more
- Planned Parenthood of Central and Western NY (Syracuse, NY)
- …regulations as well as having a clear understanding of laws impacting utilization management of credentialing for government health plans as well as auditing ... under their respective delegated credentialing agreements. + Works collaboratively with Clinical Services and Human Resources to develop and implement seamless… more