- Healthfirst (NY)
- …accredited institution or equivalent work experience NYS RN Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care ... authorization, concurrent review, and service requests Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers,… more
- CenterWell (Albany, NY)
- …and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal ... Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization… more
- Healthfirst (NY)
- …Medicaid and//or Managed Long-Term Care Plan (MLTCP).** + **Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care ... **Duties//Responsibilities:** + **Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations,… more