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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 5 days ago - UpvoteDownvoteShare Job
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Navigates Allscripts EMR (Acute Care) and communicates with Practice Administrative staff or Care providers to retrieve required clinical utilization data to facilitate insurance carrier review and expeditious authorization approval.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Conduct utilization review, incident management and review and quality assurance reviews. · Review all admissions to the residence and assigns cases accordingly. Review all discharges and ensure appropriate referrals for all clients discontinuing treatment.
$70,000 - $75,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Establishes and maintains good working relationships with contracting agencies, community organizations and consumers; assists with utilization review as needed. Participate in hiring, continuous progress review and disciplinary procedures.
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Recent experience in case management, home health, utilization review, and or unit clinical specialty required. He/she is responsible to ensure compliance with regulatory standards related to level of care determinations, utilization and discharge planning.
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Conduct mediation reconciliation and drug utilization review (DUR) to assure safety and appropriateness of medications. Review patient profile to ensure appropriate drug selection and dosage (no drug duplication, interactions or allergies) and route of administration, with accurate and complete information.
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The Sr. Electrical Engineer IV – Electrical Engineering (Sr. Substation Engineer) serves as a lead engineer to provide high level engineering to develop conceptual and detailed designs and review designs provide by 3rd party engineers for of electrical substations for utility scale renewable power plants (wind & solar) and battery storage systems.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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The Staff Pharmacist reports to the Associate Director of Retail Pharmacy Services and prepares, compounds and dispenses medications for outpatient and ambulatory care use as well as dispenses retail and specialty pharmacy related items.
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May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
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Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.
$96,682 a yearFull-timeExpandUpdated 14 days ago - UpvoteDownvoteShare Job
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Develops, updates, and teaches curriculum, exercises and learning materials for clinicians in conjunction with the Learning & Development and Quality departments to improve on utilization management.
$93,400 a yearExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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2 -3 years of Utilization Review experience at a Managed Care Organization is preferred. The Senior Director of Clinical Review will monitor the Clinical Review Nurse's activities and outcomes, ensuring compliance with established regulatory and contractual requirements.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Maintain monthly statistical reports to measure utilization review for all OASAS and OMH licensed programs. Utilization of screening tools to assess for the lowest level of clinical care, along with wrap around services.
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Supervises professional and clerical employees who work with a range of functions, including but not limited to: access, pre-authorization and precertification, bed placement, coding, utilization review and denial management, care coordination collaborative treatment planning and core measures, discharge planning, clinical social work, tracking of the post-acute period and provision of disease management, and contracting internally and externally.
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The organization desires certified teachers; however, upon individual approval from the non-public school, a non-certified teacher can be hired based upon credential/experience review. Attends training sessions, passes content assessment, and delivers designated instructional models and strategies in readiness, reading, mathematics, and/or writing skills to eligible students through utilization of Company-designed materials and educational strategies.
Full-timeExpandApply NowActive JobUpdated 13 days ago
utilization review jobs in New York, NY
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