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220 Medical jobs

Utilization Management RN/LPN

Healthfirst Inc. — New York, NY,

to evaluate the appropriateness and medical necessity of treatments and service utilizations based ... on clinical documentation, regulatory, and InterQual/MCG criteria Assessment - identifying medical ... medical providers to coordinate treatments, collateral services, and service authorizations. Negotiates

Reference no: 1067147 Posted on: 04/22/2021
Utilization Management - Foster Care

Healthfirst Inc. — New York, NY,

and medical attention and addresses identified member needs across the continuum of care. The Care ... The Care Manager plans and manages behavioral and/or physical care with members ... and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care

Reference no: 1067149 Posted on: 04/22/2021
Support Coordinator - Bilingual Spanish

Healthfirst Inc. — New York, NY,

Department. Demonstrated ability to document calls into a computer system. Knowledge of medical ... . Demonstrated ability to document calls into a computer system. Knowledge of medical terminology ... The Support Coordinator is responsible for assisting the care/case managers with non-clinical

Reference no: 1067150 Posted on: 04/22/2021
Director of Nursing

University of Minnesota — Twin Cities, Minnesota, United States

The UMN has suspended hiring for most positions. However, we will continue hiring for positions ... critical to the University's mission and operations at this time. Applications are being accepted ... for this position and you are encouraged to apply. In-person interviews are suspended indefinitely

Reference no: 11395546 Posted on: 04/21/2021
Case Manager - Foster Care

Healthfirst Inc. — New York, NY,

the appropriateness and medical necessity of treatments and service utilizations based on clinical documentation ... , regulatory, and InterQual/MCG criteria o Assessment - identifying medical, psychological ... , and social issues that need intervention. o Coordination - partnering with PCP and other medical providers

Reference no: 1066603 Posted on: 04/21/2021
Utilization Management - Foster Care

Healthfirst Inc. — New York, NY,

and medical attention and addresses identified member needs across the continuum of care. The Care ... The Care Manager plans and manages behavioral and/or physical care with members ... and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care

Reference no: 1066604 Posted on: 04/21/2021
Team Leader, A&G Quality Assurance

Healthfirst Inc. — New York, NY,

The Quality Assurance Team Leader in Appeals and Grievances is responsible for managing ... and performing Internal Quality Assurance Audits of Operational processes for internal employees and outsourced ... vendors to ensure compliance with policies, procedures and quality standards. The incumbent

Reference no: 1066605 Posted on: 04/21/2021
Dental Peer Reviewer - NY Licensed D.M.D ... . or D.D.S.

Healthfirst Inc. — New York, NY,

in consulting on medical necessity in the context of dental appeals and ensuring adherence to internal ... : The Dental Peer Reviewer will assess/review dental appeals based on medical records and internal ... of work each day. The Dental Peer Reviewer will: Collaborate with Appeals & Grievances and medical

Reference no: 1066606 Posted on: 04/21/2021
Pediatric Care Manager

Healthfirst Inc. — New York, NY,

and medical attention and addresses identified member needs across the continuum of care. The Care ... members. The Care Manager facilitates care and medical attention and addresses identified member needs ... to standards of care for children including but not limited to developmentally disabled, medically

Reference no: 1066977 Posted on: 04/21/2021
Clinical Service Auditor

Healthfirst Inc. — New York, NY,

of medical necessity. - Follows up with providers to ensure outstanding issues are resolved ... such as medical records review; claims processing; managed care plan products (e.g. Medicaid, Medicare ... , PEGA, Citrix, RightFax, VoIP, Virtual work platforms (VPN), Electronic medical record (EMR

Reference no: 1066984 Posted on: 04/21/2021
Clinical Auditor: Appeals and Grievance, RN ... or LPN

Healthfirst Inc. — New York, NY,

but are not limited to the review of Appeals and Grievances, medical authorizations, and supporting ... experience such as medical records review; claims processing; A&G, utilization/case management ... ); Geriatrics, Medical Surgical Nursing, Case Management or Discharge Planning; etc. Experience working

Reference no: 1066985 Posted on: 04/21/2021
Project Manager- Clinical Implementation

Healthfirst Inc. — New York, NY,

summaries with actionable steps on care and utilization management efforts, medical cost savings ... The Project Manager will be responsible for reporting development, maintenance and analysis ... of clinical operations data or the development of new process/ existing process improvement efforts

Reference no: 1066994 Posted on: 04/21/2021
Manager, Clinical Quality

Healthfirst Inc. — New York, NY,

groups about missing services lists. - Maintain medical records department contacts, and knowledge ... of medical record/EMR systems. Facilitate/own retrieval of medical records. - Attend and facilitate ... with assigned providers. - Partner with any on-site Medical Management staff to maximize member outreach

Reference no: 1067012 Posted on: 04/21/2021
Certified Pharmacy Technician, UM

Healthfirst Inc. — New York, NY,

and review of prior authorization requests for medications requested under the medical benefit ... is part of multidisciplinary team and will work closely with Providers, Pharmacists, and Medical ... Directors. Duties & Responsibilities: Review prior authorization requests and units for medications

Reference no: 1067013 Posted on: 04/21/2021
Certified Pharmacy Technician - Bilingual Spanish ... /English

Healthfirst Inc. — New York, NY,

and review of prior authorization requests for medications requested under the medical benefit ... is part of multidisciplinary team and will work closely with Providers, Pharmacists, and Medical ... Directors. Duties & Responsibilities: Review prior authorization requests and units for medications

Reference no: 1067014 Posted on: 04/21/2021
Case Manager - Foster Care

Healthfirst Inc. — New York, NY,

the appropriateness and medical necessity of treatments and service utilizations based on clinical documentation ... , regulatory, and InterQual/MCG criteria o Assessment - identifying medical, psychological ... , and social issues that need intervention. o Coordination - partnering with PCP and other medical providers

Reference no: 1067018 Posted on: 04/21/2021
Utilization Management - Foster Care

Healthfirst Inc. — New York, NY,

and medical attention and addresses identified member needs across the continuum of care. The Care ... The Care Manager plans and manages behavioral and/or physical care with members ... and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care

Reference no: 1067019 Posted on: 04/21/2021
Team Leader, Non-Clinical Specialist

Healthfirst Inc. — New York, NY,

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 works in collaboration with divisions within and outside

Reference no: 1067027 Posted on: 04/21/2021
Bilingual Spanish Care Manager

Healthfirst Inc. — New York, NY,

and medical attention and addresses identified member needs across the continuum of care. The Care ... The Care Manager plans and manages behavioral and/or physical care with members ... and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care

Reference no: 1067032 Posted on: 04/21/2021
Care Manager

Healthfirst Inc. — New York, NY,

and medical attention and addresses identified member needs across the continuum of care. The Care ... The Care Manager plans and manages behavioral and/or physical care with members ... and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care

Reference no: 1067046 Posted on: 04/21/2021

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