- 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 ... regulatory agencies, and other health care related entities. Preferred Qualifications: Utilization Review /Managed Care/ Quality Assurance experience.… more
- WMCHealth (Valhalla, NY)
- …hospital or health care agency, one of which must have been in the area of utilization review , quality assurance , risk management or discharge planning. ... the implementation or investigation of the procedures specified in the Quality Management, Utilization Review and Discharge Planning Program at Westchester… more
- WMCHealth (Poughkeepsie, NY)
- …either a hospital, health care agency or managed care company in the area of utilization review , quality assurance , risk management or discharge ... by implementation or investigation of the procedures in the Utilization Review and Discharge Planning program at...and Det Norske Veritas (DNV) standards. + Ability to review , analyze and investigate Quality Assurance… more
- CenterLight Health System (Flushing, NY)
- …(5+) years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... model. + Escalates questions or concerns during the assessment to the quality review team to ensure appropriate completion of UAS-NY and handling of on-site… more
- FlexStaff (New York, NY)
- …(3-5) years of experience in care/case management, disease management, population health management, utilization review , quality assurance , or discharge ... and referral sources through various channels. + Escalates assessment-related concerns to quality review for proper UAS-NY completion and issue resolution. +… more
- CVS Health (Albany, NY)
- …As a Medical Director you will focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews ... is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a remote based… more
- Catholic Charities Family Community Services (Newark, NY)
- …and other record keeping as necessary for program accountability + Participates in monthly Utilization Review , quality assurance and program evaluation ... activities as directed. + Coordinates discharge planning for clients + Provides education to clients on health and wellness issues. + Participates in staff meetings and clinical supervision as directed + Actively pursues development of professional… more
- HCR Home Care (Rochester, NY)
- Role and Responsibilities The Utilization Review Specialist is responsible for performing utilization review activities including technical audit of ... medical records. This position is critical to the organizations Quality Assurance and Compliance programs to ensure...action as needed. + Provide staff training for new Utilization Review initiatives and monitors the performance… more
- Ellis Medicine (Schenectady, NY)
- …and appropriateness of all prescriptions filled by completing the Drug Utilization Review and Final Quality Assurance , applicable to state and federal ... good service? Do you treat every person with dignity and thrive in an environment where quality of service comes first? If you share these values, we want to talk to… more
- VNS Health (Manhattan, NY)
- …strictly and timely. + Participates in development and implementation of the Quality Assurance and Compliance initiatives; collaborates across team, regions and ... CEU credits, and advancement opportunities What You Will Do + Reviews specific utilization issues or requests with Clinical Review team, focusing on problem… more
- Helio Health Inc. (Syracuse, NY)
- …program's efforts to track, review , and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis ... quality of care and/or life. + Performs quality assurance activities to include: + Provides...Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care,… more
- University of Rochester (Rochester, NY)
- …preferred. - Clinical chart review and abstraction experience preferred. - Quality Assurance and Process Improvement (QA/PI) experience preferred. - RN - ... the application of strict inclusion/exclusion criteria and protocols. - Performs meticulous chart review and enters clinical data into the quality databases to… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …staff as needed with assuring compliance with external and internal utilization review / quality and appropriateness requirements. What qualifications ... or related field strongly preferred + Minimum of one year clinical or quality assurance experience in behavioral healthcare/human services organization. + Must… more
- Global Foundries (Malta, NY)
- …Global Process Owner (GPO) and cross-functional teams to ensure alignment of quality assurance initiatives with overall business objectives, meet compliance ... Junction, VT . We are looking for a Technology Quality Engineer to join our team as part of...+ Accountable for effective execution of the TRB (Technology Review Board) business process at our fabrication (Fab) sites… more
- Comunilife (New York, NY)
- …The Program Coordinator will perform evaluations and maintain Comunilife policies and procedures, quality assurance , utilization review and outreach ... with the Sr. Vice President of Programs to assure quality psychiatric and psychosocial assessments are conducted prior to...+ Triage referrals and patient assignments to staff; monitor quality of clinical service and maximize number of individuals… more
- Catholic Health Services (Melville, NY)
- …of New York, as applicable. Certification by American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred. 4. Knowledge, ... Initiatives Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical… more
- Centene Corporation (New York, NY)
- …for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. + Prepares case reviews for Medical ... applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA… more
- WMCHealth (Kingston, NY)
- …counselors + Implement policies and procedures, service delivery standards, quality assurance and utilization review standards, and Kingston Hospital ... nursing division policies and procedures and standards of nursing care. + Performs any other duties as assigned. + Schedule appointments for physicians and prescribing professionals. + Initiate, monitor, and obtain toxicology. + Register medications and access… more
- Kaleida Health (Buffalo, NY)
- …and DeGraff Rehabilitation and Skilled Nursing Facility. Interprets and implements quality assurance , performance improvement and safety standards to ensure ... leadership role required. 2 years of experience in a healthcare Quality Assurance Performance Improvement role preferred. **Working Conditions** **Working… more
- Independent Health (Buffalo, NY)
- …current and accurate database. + Provide high quality , professional utilization management services: (medical necessity review for Prior Authorization, ... the RN staff of their assigned area (Case Management, Utilization Review and Population Health). This will...policies and procedures. + Develop and implement the department's Quality Assurance plan. + Use and maintain… more