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Program Coordinator I (1082591) Position Purpose Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verify
Posted 25 days ago
Military Family Life Counselor (1080525) Position Purpose This description should be used exclusively with the SPA Salary Structure. The Counselor is a licensed mental health professional who exercises discretion and independent judgment to provide appropriate information, coaching, training, and education to Service Members and their families. Partners with and augments activities of Service Fami
Posted 1 month ago
Medical Director NY Rochester (Board Certified FP or IM preferred) (1078453) Position Purpose Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review act
Posted 1 month ago
Utilization Review Nurse (008SU) Position Purpose Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to
Posted 1 month ago
Utilization Manager (1081383) Position Purpose Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings, provide and/or review intakes and initial evaluations, brief focused treatment interventions, monitor quality of care, collect and analyze utilization and cost of care data, assist with disc
Posted 1 month ago
Provide hands on training to clinical staff in Medical Management on the various aspects of their job functions and responsibilities. Provide an avenue of consistent training among the clinical staff; define expectations of each specific role for accountability and facilitate clinical training for the staff. This position will also include monthly staff quality chart audits with the utilization of
Posted 1 month ago
Perform duties related to the day to day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Treatment Plan, monitor quality of care; assisti
Posted 1 month ago
Military Family Life Counselor (1080521) Position Purpose This description should be used exclusively with the SPA Salary Structure. The Counselor is a licensed mental health professional who exercises discretion and independent judgment to provide appropriate information, coaching, training, and education to Service Members and their families. Partners with and augments activities of Service Fami
Posted 2 months ago
Perform duties related to the day to day operations of the High Risk Case Management functions to include working with members identified as high risk to identify needs and goals to achieve empowerment and improved quality of life. Assess members' current functional level and, in collaboration with the member, develop and monitor the Case Management Treatment Plan, monitor quality of care; assisti
Posted 2 months ago
Assist the health plan in establishing a presence in the community through home visits and community outreach. Educate members on health care benefits through home visits and outreach Assist members with activities related to accessing care Document information and activities in applicable systems Deliver Connections Plus cell phones, teach and answer questions related to cell phone use and naviga
Posted 3 months ago
Concurrent Review Nurse I (1062189) Position Purpose Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested servic
Posted 3 months ago
Health Net
- Rochester, NY
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past and present treatment plan and services, prognos
Posted 3 months ago
Care Manager I (RN) (1072042) Position Purpose Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care Develop, assess and adjust, as necessary, the care plan and promote desired outcome Assess the member's current health status, resource utilization, past an
Posted 3 months ago
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