• Director Physician Advisor

    Catholic Health Services (Melville, NY)
    …and standardize the implementation of CM processes and policies, as well as the Physician Advisor role, activities and expectations. Collaborates with CM and CDI ... to Physician Advisors through annual performance evaluation. Monitors Physician Advisor performance dashboard with Key Performance Indicators (KPIs).… more
    Catholic Health Services (03/05/25)
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  • Physician Advisor

    Mohawk Valley Health System (Utica, NY)
    PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job Summary The Physician Advisor collaborates with Care Managers and Attending Physicians to align on the ... care, patient billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with… more
    Mohawk Valley Health System (12/18/24)
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  • Physician Advisor

    Catholic Health Services (Melville, NY)
    …peer-to-peer calls and advise on continued stay reviews that require additional Physician Advisor input. Knowledge of appeals process and necessary documentation ... experience as a member of the UM oversight committee or past Physician Advisor experience preferred. Ability to travel to the various Catholic Health locations.… more
    Catholic Health Services (03/05/25)
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  • Case Manager (Inpatient Units)

    Ellis Medicine (Schenectady, NY)
    …prior to implementation of discharge plan + Collaborates and makes referrals to physician advisor when unable to resolve issues with attending physician ... physician , nurse or ancillary staff member. Make appropriate referral to physician advisor regarding trends/areas of concern + Proactively monitors patient… more
    Ellis Medicine (03/14/25)
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  • Staff Nurse- Case Manager- Mount Sinai West- Part…

    Mount Sinai Health System (New York, NY)
    …and responsive to the diverse backgrounds and experience of others. * Liaison with Physician Advisor . 2. Case Management: * Assessment of the patient's clinical, ... reduce readmission rate. * Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum of… more
    Mount Sinai Health System (01/15/25)
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  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …or regulatory timeframes. |Collaborates in clinical discussions with the Catholic Health Physician Advisor when appropriate. |Reviews results from managed care ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...between the Utilization and Appeals Management Department and the physician of record, as required. |Communicates changes to patient… more
    Catholic Health Services (02/14/25)
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  • Manager, RN - In-Patient Hospital Case Management…

    Mount Sinai Health System (New York, NY)
    …Managers, as warranted, to review medically complex and long stay cases; refer to physician advisor as indicated. 3. Collaborates with Social Work Supervisors to ... Managers to review medically complex and long stay cases: refer to physician advisor as required. 12. Collaborates with Social Work Supervisors to resolve… more
    Mount Sinai Health System (02/18/25)
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  • RN/Case Manager-MSH-Case Management-Full Time-Days

    Mount Sinai Health System (New York, NY)
    …to reduce readmission rate. h. Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum ... standardized criteria to justify continued inpatient stay. c. Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and… more
    Mount Sinai Health System (03/07/25)
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  • ED Case Manager RN- Mount Sinai Morningside- Full…

    Mount Sinai Health System (New York, NY)
    …to reduce readmission rate. 8. Appropriately identifies and refers cases to the physician advisor to support timely progression of patients along the continuum ... standardized criteria to justify continued inpatient stay. 3. Collaborates with Physician and other clinicians to expedite diagnostic testing, treatment and… more
    Mount Sinai Health System (03/04/25)
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  • CHS Utilization and Appeals Coordinator

    Catholic Health Services (Melville, NY)
    …Manage Care Payors or regulatory agencies, as needed or requested. | Manages physician advisor reports and assists with facilitating UM Committee reviews when ... hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the… more
    Catholic Health Services (02/14/25)
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  • Case Manager - Case Management

    Arnot Health (Elmira, NY)
    …in matters of auth/denial review decisions. 8. Maintains a working relationship with Physician Advisor regarding physician issues related to auths/denials. ... 9. Provide insurance companies with requested patient information as needed. 10. Maintains a working knowledge of programs necessary for denial management (ie: excel, word, QCPR, Sorian, InterQual, eCW) 11. Maintains files and all letters of non-coverage. 12.… more
    Arnot Health (02/06/25)
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  • Nurse Case Manager - Full Time, Days

    Nuvance Health (Poughkeepsie, NY)
    …and at a minimum the case manager reviews observation cases daily. 3. Utilizes physician advisor to interface with physicians as needed. 4. Collaborates with the ... Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology… more
    Nuvance Health (01/26/25)
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  • Utilization Management RN

    Ellis Medicine (Schenectady, NY)
    …to determine appropriate reimbursement and appropriate status. * Escalates reviews timely to physician advisor timely for lack of medical necessity and/or status ... care facilities and providers. * Effectively communicates with the patient, family, physician and health care team to ensure understanding of appropriate management… more
    Ellis Medicine (01/02/25)
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  • Case Manager- Case Management

    Arnot Health (Elmira, NY)
    …the Case Management practice. The Case Manager will work cooperatively with the Physician Advisor and Team. DUTIES AND RESPONSIBILITIES: ** 1. Determines medical ... necessity and appropriateness of admission and stay in accordance with Interqual. ** 2. Prepares Medicare/Non Medicare hospital notices of noncoverage (HINN) when patient's level of care is no longer covered according to the guidelines. ** 3. Identifies the… more
    Arnot Health (02/06/25)
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  • Director Clinical and DRG Denials

    Kaleida Health (Buffalo, NY)
    …as facilitating strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments ... and leadership to promote effective clinical validation improvement and clinical denial management system-wide. Significant influence on system quality and financial outcomes. **Education And Credentials** **Responsibilities:** Bachelor degree in health… more
    Kaleida Health (12/19/24)
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  • Senior Academic Advisor (ACE Program)

    CUNY (Queens, NY)
    Senior Academic Advisor (ACE Program) **POSITION DETAILS** York College, founded in 1966, is a center of academic excellence in the heart of Jamaica, Queens. One of ... Aviation Management, Clinical Trials Management, Pharmaceutical Science and Business, Physician Assistant, Social Work and Nursing Education. Located in Queens,… more
    CUNY (03/04/25)
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  • Part-Time Practice Performance Advisor

    Evolent (Albany, NY)
    …more connected care journey. We are hiring for a Part-Time Practice Performance Advisor to join our Evolent Care Partners Performance Team. The Part-Time Practice ... Performance Advisor will serve as the local expert and resource...will travel throughout designated territory to build relationships with physician practices to support physician engagement, clinical… more
    Evolent (01/18/25)
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  • Academic Advisor

    CUNY (New York, NY)
    Academic Advisor **POSITION DETAILS** The CUNY School of Medicine (CUNY SoM) located in the heart of Harlem, New York, is the only medical school in the City ... 2016. The CUNY SoM offers an accelerated BS/MD degree (7-year program) and a Physician Assistant Master's Degree (27 months program). True to its legacy of access,… more
    CUNY (02/24/25)
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  • Practice Performance Advisor (Must Reside…

    Evolent (Albany, NY)
    …your mark on health care. **Collaboration Opportunities:** The Practice Performance Improvement Advisor will serve as the local expert and resource for Evolent Care ... region for value-based care initiatives. The Practice Performance Improvement Advisor will travel throughout designated territory to build relationships with… more
    Evolent (03/04/25)
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  • Practice Performance Advisor (Must Reside…

    Evolent (Albany, NY)
    Advisor will be primarily responsible for primary care physician IPA (Individual Practice Association and/or MSO (Management Services Organization) engagement ... more connected care journey. We are hiring for a Practice Performance Advisor to join our Provider Relations Team. **Collaboration Opportunities:** The Practice… more
    Evolent (03/09/25)
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