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By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth.
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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
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Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
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This experience typically includes: monitoring occupant space utilization, energy and water conservation, sustainability and environmental hazards programs; coordinating alteration and renovation projects; gathering information to assess the level of customer satisfaction, i.e., surveys, interviews with tenant contacts, focus groups; monitoring real property budgetary and financial data; and, administration of repair and/or operation and maintenance contracts.
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Participate in job-related committees, such as Substance Abuse, Utilization Management, Safety, and Risk Management. Supervise and assist clinicians in the use of formal and informal resources for the client, including transition, discharge, and aftercare plans of behavioral health services, outreach services, etc.
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Responsible for data and report generation of providers as well as regulatory agencies, as needed for Utilization Management activities. Utilizes Hospital Mainframe programs, CANOPY Care Management System, and TRAC effectively and coordinates updates with Insurance Verification, Social Work management, and Patient Accounts as appropriate.
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The Utilization Management Coordinator is responsible for all utilization management activities for assigned cases from admission through discharge, including peer reviews and appeals, in accordance with the Utilization Review Plan, for patient population ages 5 years through 21 years, with significant behavioral health needs and Autism Spectrum Disorders or other developmental disorders.
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Currently, SJCC’s main services consist of case assistance/management, operating a large food pantry, and immigration services, and a large portion of its clients are Russian-speaking older adults, including a large number of Holocaust survivors.
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Supporting individuals with aftercare providers upon discharge from ERs, Detox Units, Inpatient Psychiatric Units, etc. Arranging for aftercare services (appointment dates, contact information, etc.
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We are seeking an experienced Warehouse Management Systems (WMS) Analyst that will join the Supply Chain Technology team. · Deep knowledge of WMS technology (preferably Manhattan Active WM); Labor Management (LM) and Material Handling Equipment (MHE) systems experience is a plus.
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We are seeking a Business Analyst/Incident Manager with expertise in ServiceNow IT Service Management (ITSM) to join our dynamic team. · Hands-on experience with ServiceNow ITSM platform, including incident management, problem management, and change management modules.
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Provide general paralegal support to USND Business and Legal Affairs in connection with distribution of Paramount television networks and streaming services on a variety of distribution platforms.
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Records and Archives Management (RAM), within the Bureau of Business Information Technology, oversees the agency records management program in compliance with citywide policies and in coordination with the NYC Department of Records and Information Services.
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Data Management: Oversee the collection, processing, and utilization of data for training the chatbot, ensuring sensitivity and compliance with data protection regulations. Minimum of 5 years of experience in cloud infrastructure design and management, with a strong focus on Microsoft Azure.
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Provide general paralegal support to USND Business and Legal Affairs in connection with distribution of Paramount television networks and streaming services on a variety of distribution platforms.
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utilization management aftercare jobs Company: Metroplus Health Plan in Brooklyn, NY
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