- Molina Healthcare (Buffalo, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Molina Healthcare (Buffalo, NY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Independent Health (Buffalo, NY)
- …**Overview** The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals ... document research of initial coverage determinations, and lead coordination of clinical review with appropriate internal stakeholders and Medical Director. This… more
- Catholic Health (Buffalo, NY)
- …for the people, carrying out and documenting the appeals process for denied claims denied due to reasons including, but not limited to clinical documentation/support ... for diagnostic related grouping (DRG) assignment, inpatient and outpatient medical necessity. The individual also works to maintain third-party payer relationships.… more
- Independent Health (Buffalo, NY)
- …service to all internal and external customers. **Qualifications** + Registered Nurse (RN) with active, current, unrestricted NYS license, licensed master social ... Two (2) years of case management or clinical experience in acute medical /surgical/critical care or ambulatory setting required. + Proficient computer and Windows… more