- UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Position Overview Under the direction of the Medical Director for Partnership in Care (PIC), the Director of Care Management (PIC) provides clinical and administrative direction to Partnership in Care care management staff who are focused on providing high quality clinical support and health education to members with HIV and those at risk of HIV infection to ensure these members receive the best possible care and achieve optimal health and wellness.
$150,000 - $157,236 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
- Suggest Revision
Provide expert guidance and training to stakeholders on insider risk management best practices and the utilization of Proofpoint ObserveIT. Stay abreast of the latest insider risk trends, technologies, and regulatory changes to continuously enhance the institution's insider risk posture.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Supports Utilization Management (UM) department staff and nurse Care Managers on concurrent review and preauthorization referrals and ensures that members receive appropriate services consistent with their benefits, regulatory requirements, and established clinical criteria.
$175ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Conduct utilization review, incident management and review and quality assurance reviews. The Clinical Supervisor is responsible for maintaining OASAS regulatory compliance and assuring that programs operate in accordance with VIP Community Services organizational standards.
$70,000 - $75,000 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Foreign Medical Graduate; and, two (2) years of medical records review or utilization and case management experience; or. Clinical Document Specialist (CDIS): under the supervision of the leadership of the Director of Health Information Management or designee is responsible to review medical records for appropriate documentation that will assist to enhance appropriate documentation that will enhance reimbursement, and improve documentation in order to be in-compliance with regulatory agencies and reduce denials.
Full-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Software and Systems group within Tax Reporting & Strategy (TRS) offers management consulting services to clients and to their large corporate tax functions, by monitoring and analyzing legislative and regulatory tax developments, developing strategies in anticipation of tax law changes and regulatory developments, analyzing the economic impact of tax legislation and federal budget proposals, and addressing technology needs for tax function effectiveness.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Monitor risk taking and limit utilization; engage in breach remediation, and escalation workflow, propose appropriate risk treatment across internal stress testing and regulatory reporting requirements for existing and new business activities.
$110,000 - $140,000Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Biosolids Practice Leader will lead the development and implementation of business strategies across North America in coordination with Wastewater Market Sector leadership and other technical Business Class Directors (e.g. wastewater treatment, biogas utilization, conveyance, asset management, etc.
$130,410 - $242,190 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
- Suggest Revision
Familiarity with utilization management/case management. The Managed Care Coordinator (MCC) is expected to insure high quality, cost-effective care and services for Elderplan/HomeFirst members through support of professional Care Management activities.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The position supports all aspects of care coordination for our Medicaid, and/or dual product members in compliance with all departmental and CMS/DOH regulatory requirements. The position requires excellent communication and organizational skills to facilitate superior care management and to act as a liaison between the members, the care management team, and the vendors.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Expertise in utilization management including standard utilization and financial metrics. Expertise in population health management with application to physician practice improvement.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our regulatory guidelines.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Qualifications: High School Diploma or equivalent; college degree preferredOne year prior managed care experience requiredPrior experience in a health care setting preferredFamiliarity with utilization management/case management.
$38,545.53 - $48,181.92 a yearFull-timeExpandApply NowActive JobUpdated Today
utilization management regulatory jobs in New York, NY
FEATURED BLOG POSTS
Talent Mapping for the Rest of the Year
As you enter the next quarter of 2023, it's important to reflect on how well your talent strategy is aligning with your business goals. This is an opportune time to design or reassess your talent mapping approach, so your recruiting and hiring scheme going forward stays in line with this year's business goals.
How To Decorate a Cubicle for Inspiration & Productivity
You know the negative reputation cubicles have – dull, dreary, gray. How can you possibly be expected to sit in one every day and be your naturally productive, enthusiastic, and upbeat self? The answer lies in decorating your cubicle so it sparks creativity and feels welcoming. While this might seem impossible given the bland canvas you have to work with, take heart because it’s totally doable!
How do Employers Verify Education?
At any stage in your professional journey, you may come across an employer or a recruiter who asks to verify your educational credentials. This shouldn’t come as a surprise as 30% of candidates admitted to lying on their resumes, yet 79% of them never get caught. In fact, 85% of employers in the US who conduct background checks find that candidates have lied on their resumes or job applications.
How to Be More Articulate and Speak More Clearly
Have you ever had those moments when you're talking to someone and have no idea what they are saying? The best response you can muster up is a simple head nod or blind agreeance?
How to Ask for a Higher Starting Salary
Maybe you think you’ve finally found your dream job. Everything about it is perfect, except… the salary. Unfortunately, it just isn’t where you want it to be. So, should you give up and move on? Given all the effort you’ve already invested, it’s probably wise to try and negotiate a better salary before you do.
How to Pass a Personality Test with Flying Colors
Whether you’re applying for your first job or looking to move up the career ladder, personality tests aren’t usually the first thing we think about. But surprisingly, they can have a massive impact on how our future employers perceive us. In fact, a 2017 study by the Society for Human Resource Management (SHRM) has found that 32% of U.S. employers use personality tests when hiring for senior management positions, and 28% use them for middle management positions. Personality tests are also used for hourly workers and contractors, though less frequently.
10 Practical and Effective Strategies to Persuade Anyone of Anything
Learning how to persuade people is like a key that can unlock any door. Acing the interview for the job of your dreams. Getting the best deal on a new car. Closing a sale with a skeptical customer. All of these wins require a level of persuasiveness.