- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Buffalo, NY)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Independent Health (Buffalo, NY)
- …with the core components of the client centric delivery model. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS license ... database. + Provide high quality, professional utilization management services: ( medical necessity review for Prior Authorization, pre-certification, and… more
- Independent Health (Buffalo, NY)
- …with regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... Clinical Reviewer will be responsible for the collection and review of medical records specific to quality...such as Outlook, Word, Excel, and specific clinical and claims platforms. + Possess initiative, attention to detail, and… more
- Catholic Health (Buffalo, NY)
- …finance, business management, operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted ... 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… more
- Independent Health (Buffalo, NY)
- …exceptional customer service to all internal and external customers. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... Two (2) years of case management or clinical experience in acute medical /surgical/critical care or ambulatory setting required. + Proficient computer and Windows… more
- Independent Health (Buffalo, NY)
- …statistics. + Perform validation of diagnosis and procedure coding by reviewing medical record documentation and/or provider claims data. Ensure coding ... policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with Medical Director, response to… more