Utilization Review Manager - Home Care jobs in New York
Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
Recently Added Utilization Review Manager - Home Care jobs
Utilization Review Care Manager
- Wellbridge Addiction Treatment and Research
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Calverton, NY
FULL_TIME
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Position Summary
The Utilization Review Care Manager performs initial, concurrent, and retrospective reviews with various payers. Care managers request appropriate level of care based on NYS LOCADTR and medical necessity.
The Utilization Care Manager partners with several key front-end teams in addition to clinicians to serve as a subject matter expert on complex financial questions. They must have in-depth insurance knowledge and general knowledge of the roles and workflow of stakeholder departments. In all work, a high attention to detail and a respect for integrity and confidentiality is always maintained.
Responsibilities- Maintains thorough knowledge of insurance carriers and third-party administrators and are well versed in the various types of benefit plans including PPOs, HMOs, EPOs, tribal plans, Single Case Agreements, public insurers, unions, EAPs and Cobra.
- Understands and follows all HIPAA and CFR42 requirements.
- Completes initial review, continued stay reviews, and retrospective reviews; provides clinical information after patient discharges.
- Coordinates appeal process with concurrent denials from third party payers within contractual or appropriate time frames, as needed.
- Effectively communicates with multidisciplinary team if there are issues with insurance coverage or authorizations.
- Collaborates with the physicians and clinical team in determining the appropriate level of care using NYS LOCADTR.
- Provides timely communication, documentation, and obtain required signatures in the event of an insurance denial, paying careful attention to follow utilization review workflows.
- Promotes staff development and education through live training initiatives.
- Participates in departmental continuous quality improvement activities and committees.
- Audits caseload daily up to weekly to ensure appropriate insurance, self-pay or out of network information is reflected in each encounter. Conducts a final review of all encounters at the close of the calendar year.
- Performs related duties, as required.
- Bachelor’s degree in a health care or behavioral health specialty and CASAC required.
- Master’s Degree in Social Work, Nursing, Mental Health Counseling, or other behavioral health specialty preferred.
- Knowledge and experience with NYS OASAS LOCADTR
- Minimum of three (3) years clinical experience including case management, utilization management, discharge planning; third party payment systems, appeals and denial processes, preferred.
The salary range for this position is $66,000 - $73,000/year - 14 Days Ago
Nurse Manager Utilization Review
- Clinical Management Consultants
-
Newburgh, NY
FULL_TIME
- A leading acute care hospital located in southeastern New York is now searching for an experienced Nurse Manager Utilization Review to join their award-winning healthcare team.This acute care facility...
- 3 Days Ago
Case Manager/Utilization Review
- Midas Consulting
-
White Plains, NY
CONTRACTOR
- Understands and adheres to the WPH Performance Standards, Policies and Behaviors Completes a comprehensive initial assessment. Performs all activities for multidisciplinary care coordination at the in...
- 7 Days Ago
Nurse Manager Utilization Review
- Clinical Management Consultants
-
Suffern, NY
FULL_TIME
- A leading acute care hospital located in southeastern New York is now searching for an experienced Nurse Manager Utilization Review to join their award-winning healthcare team. This acute care facilit...
- Just Posted
Nurse Manager Utilization Review
- Clinical Management Consultants
-
Cortland, NY
FULL_TIME
- An award-winning acute care hospital located in central New York is currently searching for an experienced Nurse Manager Utilization Review to join their established healthcare system. This regional l...
- 18 Days Ago
Utilization Review Nurse - LTSS/DME
- Village Care
-
New York, NY
FULL_TIME
- RN- Utilization Review Nurse LTSS/DME *Full Time 100% Remote Opportunity* COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE! VillageCare is looking for a self-motivated and passionat...
- 6 Days Ago
Utilization Review Manager - Home Care jobs at Popular Companies
Environmental and Utilities Manager
- Leprino Foods
-
Lubbock, TX
- For our future state-of-the art 600+ person Lubbock, TX cheese and whey manufacturing facility, Leprino is seeking an En...
- 6/11/2024 12:00:00 AM
Gas Utilities Manager
- Accenture
-
Austin, TX
- We Are: Our Utility Industry, Transmission & Distribution Practice is powering the progress to a safe, connected, and su...
- 6/10/2024 12:00:00 AM
Director Utilization Management
- Heritage Valley Health System, Inc.
-
Beaver, PA
- Department: Utilization Review. Work Hours: Primarily Monday through Friday, extended hours as needed to support organiz...
- 6/9/2024 12:00:00 AM
Supervisor, Utilization Management
- Centene Corporation
-
Tallahassee, FL
- You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Managem...
- 6/9/2024 12:00:00 AM
Utilization Management Specialist
- Blue Cross and Blue Shield Association
-
Meridian, ID
- Our Utilization Management Rep will coordinate and manage incoming and outgoing correspondence to include referrals, pri...
- 6/9/2024 12:00:00 AM
Director of Utilization Management
- Oceans Healthcare
-
Jackson, MS
- Description The Director Utilization Management is responsible for oversight and management of all utilization review/ca...
- 6/8/2024 12:00:00 AM
Manager, Utilization Management
- Hiring Now!
-
New York, NY
- Creates and upholds policies and procedures for coverage determinations. Serves as subject matter expert for Medicare co...
- 6/8/2024 12:00:00 AM
Director Utilization Management
- Heritage Valley Health System
-
Beaver, PA
- Department: Utilization Review Work Hours: Primarily Monday through Friday, extended hours as needed to support organiza...
- 6/7/2024 12:00:00 AM
About New York
New York is a state in the Northeastern United States. New York was one of the original thirteen colonies that formed the United States.
New York covers 54,555 square miles (141,300 km2) and ranks as the 27th largest state by size.[3] The highest elevation in New York is Mount Marcy in the Adirondacks, at 5,344 feet (1,629 meters) above sea level; while the state's lowest point is at sea level, on the Atlantic Ocean.
In contrast with New York City's urban landscape, the vast majority of the state's geographic area is dominated by meadows, forests, rivers, farms, mountains, and lakes. Most of...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$81,637 to $104,073