The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN’s, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and
As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we
Longitudinal Care Manager The Longitudinal Care Manager provides ongoing care coordination and management for patients over time, ensuring continuity of care, optimal health outcomes, and appropriate utilization of services. This role supports patients across the continuum of
Care Management Nurse Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members health care needs, identifying gaps in care and needed support, administering/coordinating implementation
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G
As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we
Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances. Duties and Responsibilities: Ensures that appeals and grievances are
Care Management Nurse Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members health care needs, identifying gaps in care and needed support, administering/coordinating implementation
Clinical Position at EmblemHealth Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department. Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care. Principal Accountabilities: Under
We are sharing a specialised part-time consulting opportunity for experienced healthcare professionals across clinical practice, nursing, healthcare administration, compliance, pharmacy, health information management, medical billing, revenue cycle, health economics, and healthcare data analysis. This role supports