- Molina Healthcare (Yonkers, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Molina Healthcare (New York, NY)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (New York, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …assurance standards and MagnaCare policies and procedures. Essential Qualifications + Currently licensed Registered Nurse in the state of NY, or the ability to ... About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review / Medical and Case Management services for Group Health and Workers' Compensation… more
- CVS Health (Clifton, NJ)
- …your home. Standard Working hours Monday - Friday 8-5 pm **ICM Case Manager RN ** **WFH Flexible** **Position Summary:** Help us elevate our patient care to a whole ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...member's overall wellness. * Uses clinical tools and information/data review to conduct an evaluation of member's needs and… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …the Residence Manager, and reports all medical issues/ injuries to the registered nurse and follows protocols for notification. 13. Performs variety of ... reports and maintaining database of consumer health information after review and signed by the RN . +...+ Performs all other duties as assigned by the registered nurse . II. POSITION REQUIREMENTS A. Qualifications… more
- BronxCare Health System (Bronx, NY)
- …Licensed Practical Nurse : Under the direct supervision of a physician and/ or Registered Nurse , participates in the application of the nursing process to an ... (according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS… more
- Mount Sinai Health System (New York, NY)
- …The Senior Risk Manager supports the Risk Management staff on how best to review risk management data, conduct Root Cause Analysis, and comply with risk management ... to develop educational plans for instructing staff about the medical center's activities and the daily administration of its...to the Risk Management staff on how best to review risk management data, conduct Root Cause Analysis, and… more