Utilization Review Technician jobs in Troy, NY

Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Regulatory Quality Review Specialist
  • Denken Solutions
  • Greenwich, NY FULL_TIME
  • Job Details

    Currently, we are looking for talented resources for one of our listed clients. If interested please reply to me with your updated resume or feel free to reach out to me for more details at

    Title: Regulatory Quality Review Specialist

    Location: NYC - 388 Greenwich Street

    Duration: 8 Months Potential project extension or direct hire conversion

    Worksite Location: Hybrid (Remote and Onsite 3 days a week)




    General Responsibilities:

    • Partner with issue owners and teams to provide guidance, challenge, and quality assurance on the approach to pass IA and Regulatory scrutiny.
    • Facilitate execution of the Challenge and Quality Review Framework (1st LoD self-assessment), through engagement and credible challenge with senior stakeholders, 2nd and 3rd LoD
    • Drive compliance with the QC Framework with Accountable Executives and Issue Owners
    • Provide guidance to issue owners on how to best represent a reduction of risk and issue remediation that will pass the scrutiny of IA validation and regulatory review
    • Provide an independent initial assessment and challenge on the remediation and evidence artifacts
    • Work with stakeholders to drive challenges to ensure strategic deliveries meet the letter and spirit of management, regulator, Compliance or IA concerns
    • Build strong relationships with key stakeholders including issue owners, governance/policy owners, and program leads for intersecting work efforts
    • Execute against multiple competing priorities simultaneously
    • Ensure risks and issues are raised promptly and in accordance with Client policy
    • Ensure all programs understand regulatory feedback and expectations, underlying concerns, and their root causes to make sure their commitments are complete
    • Provide review and challenge of each program's defined scope, assessed gap, target state, and success criteria to ensure it fully addresses the letter and the spirit of the regulatory feedback, broader supervisory expectations, and underlying issues and root causes
    • Identify related and interdependent program elements and provide feedback and input to ensure consistency of review and challenge implementation according to developed guidelines
    • Review policies and risk frameworks
    • Governance and project management
    • Be proactive and self-motivated in driving quality and timely reviews/assessments end-to-end.

    Qualifications:

    • Bachelor's degree; major in Finance, Accounting, Economics or Business Administration preferred
    • 12 years of progressive experience in the financial services industry; experience in Risk Management, Internal Audit; Knowledge and understanding of regulatory and risk management in the financial services industry.
    • Experience working for a Regulator is highly desirable.
    • A critical thinker who seeks to understand the business and its control environment.
    • Recent experience in managing or leading audits and/or quality assurance reviews for a banking institution is preferred.
    • Proven leadership and project management skills to drive alignment across stakeholder groups to review and challenge repeatable end-to-end risk management solutions and controls aligned with policies, frameworks and processes.
    • Deep understanding of risk framework, corporate/business policies, and programs to translate into plans for the business, function and/or risk type.
    • Demonstrated ability to understand effective and efficient risk controls and gaps within large organizations.
    • Develop influential relationships based upon shared risk objectives and trust to deliver outstanding business impact and elevate team's value proposition.
    • Ability to work as a member of a team where success is defined not only on individual performance but also that of the entire team.
    • Excellent communication skills; ability to articulate deadlines and deliverables clearly to senior members of organization
    • Experience advising and collaborating with cross-functional internal & external stakeholders.
    • Lead through change with candor and optimism
    • Effective negotiation skills

    Education:

    • Bachelor's/University degree, Master's degree preferred.

    Technical Skills (Highlighted are "must-haves"):

    • Data Governance
    • Data Quality Management
    • Data Lineage & Tracing
    • Risk Data Testing
    • Data Architecture
    • Data Quality Strategy
    • Risk Management Skills

    Additional Information:

    • Around Data Governance, architecture, lineage, and tracking.
    • Read their data operating model and ECTO guidelines, should be able to audit.
    • Current team is Ex-Audit or Ex-regulatory background. Someone who has done data data-related audit would be ideal.
    • Certification: BCBS 239, CISA certification preferred
    • Around providing quality control on some milestones
    • Strong knowledge of the laws and regulations as they relate to a financial institution
    • Should be able to assess the scope, data lineage, data architecture
    • Minimum of 15 years of experience is acceptable

    About us:

    At our organization, we take our mission and values to heart! We are on a mission to offer more and better jobs all over the world! Our goal is to care for you while you care for our clients and get you paid the highest pay possible. All our associates working with us are expected to embrace our RACE values: R - Results Matter, A- Approachable, C - Care, and E - Emergency i.e. work with a sense of urgency.

    For more relevant job opportunities please visit our website:

  • 2 Days Ago

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Paid Product Tester
  • Product Review Jobs
  • East Wallingford, VT FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • Just Posted

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Paid Product Tester
  • Product Review Jobs
  • North Pownal, VT FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 27 Days Ago

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QA Validation Specialist - Document Review
  • Regeneron Pharmaceuticals Inc.
  • Troy, NY FULL_TIME
  • The QA Validation Oversight department is hiring! This team leads all aspects of documentation for validation areas across the business, including QC, Process Sciences, operations, CSV, gene and cell ...
  • 1 Month Ago

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Ultrasound Technician
  • Trustaff
  • Troy, NY FULL_TIME
  • As an Ultrasound Technician, you'll be the primary resource for all technical aspects of ultrasound procedures. Ultrasound Techs, also sometimes called Sonographers, must be able to provide clear imag...
  • 14 Days Ago

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Maintenance Technician
  • Vanderheyden Hall Inc.
  • Wynantskill, NY FULL_TIME
  • Primary Duties & Essential Functions: Electrical Repairs Plumbing Repairs and Services Carpentry Exterior Ground Keeping Roofing Painting Masonry Miscellaneous Custodial Required Education, Knowledge ...
  • 17 Days Ago

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0 Utilization Review Technician jobs found in Troy, NY area

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Infrastructure Technician
  • Internet Service Provider
  • Troy, NY
  • Job Description Job Description Infrastructure Technician: We are a rapidly growing company setting the new standard in ...
  • 4/23/2024 12:00:00 AM

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Supply Technician
  • Ladgov Corporation
  • Watervliet, NY
  • Job Description Job Description Job title: Supply Technician Location: Watervliet, NY Travel: N/A Duties: The applicant ...
  • 4/23/2024 12:00:00 AM

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Ophthalmic Technician
  • Pamela Kaw
  • Troy, NY
  • Job Description Job Description Candidate selected will work at Eye Health Center of Troy located at 451 Hoosick Street,...
  • 4/23/2024 12:00:00 AM

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Service Technician
  • Anderson Equipment Company
  • Latham, NY
  • Job Description Job Description Title: Service Technicians Location: Latham/Albany, NY Job Desc/Summary: Qualified candi...
  • 4/23/2024 12:00:00 AM

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Technical Specialist, Level III
  • Research Foundation for Mental Hygiene, Inc.
  • Albany, NY
  • Position Announcement Technical Specialist, Level III Grade 25 Full time Salary Range: $88,938-101,067 The Research Foun...
  • 4/22/2024 12:00:00 AM

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Pharmacy Technician
  • Jackson Pharmacy
  • Albany, NY
  • Jackson Pharmacy Professionals is the one of the nation's leading pharmacy-specific staffing and placement companies. We...
  • 4/21/2024 12:00:00 AM

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Pharmacy Benefit Technical Specialist
  • Capital District Physicians' Health Plan, Inc.
  • Albany, NY
  • Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a stro...
  • 4/20/2024 12:00:00 AM

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Technician
  • Dryer Vent Wizard Of Nassau County
  • Nassau, NY
  • Handyman ready for a change? (Nassau County) Are You Ready for a Change? National company seeks service technician for o...
  • 4/20/2024 12:00:00 AM

Troy is a city in the U.S. state of New York and the seat of Rensselaer County. The city is located on the western edge of Rensselaer County and on the eastern bank of the Hudson River. Troy has close ties to the nearby cities of Albany and Schenectady, forming a region popularly called the Capital District. The city is one of the three major centers for the Albany Metropolitan Statistical Area (MSA), which has a population of 1,170,483. At the 2010 census, the population of Troy was 50,129. Troy's motto is Ilium fuit. Troja est, which means "Ilium was, Troy is". Today, Troy is home to Renssel...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$63,816 to $89,044
Troy, New York area prices
were up 1.5% from a year ago

Utilization Review Technician in Winston Salem, NC
When considering cost of living, this places Durham, NC as 3rd out of the 4 largest nearby metros in terms of quality of life for Utilization Review Technicians**.
January 02, 2020
Utilization Review Technician in Fairbanks, AK
Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
February 03, 2020
Utilization Review Technician in Little Rock, AR
Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
February 07, 2020