- Molina Healthcare (Syracuse, NY)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Catholic Health (Buffalo, NY)
- …as related to DRG and level of care denial trends. Responsibilities: EDUCATION + Registered Nurse with a current New York State license + Bachelor of ... potential Summary: This position is accountable for carrying out and documenting the appeals process for denied claims denied due to reasons including, but not… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... hiring a Manager who is responsible for providing day to day management of the RN Care Managers in the department. Pay Range: $95,000 plus based on education and… more
- Centene Corporation (New York, NY)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry… more
- Evolent (Albany, NY)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Molina Healthcare (Syracuse, NY)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Elderwood (Waverly, NY)
- Salary $38 - $53.30 / hourly Overview Are you a Registered Nurse ( RN ) with Medicare experience? Do you consider yourself an expert in assessment and ... of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package... - MDS Coordinator - Qualifications: + Licensed Professional Nurse ( RN licensure preferred) with current license… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** ** RN /Case Manager Mount Sinai West FT Days 8a-4p...with physicians and managed care companies on concurrent denial appeals + Communicates clinical information to the… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** ** RN /Case Manager MSH Case Management FT Days** The...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
- Mount Sinai Health System (New York, NY)
- …5 years of case management experience and 5 -7 years of experience as a clinical nurse . Licensing and Certification Requirements (if applicable) License: RN ... in monthly Nursing Department meetings. 5. Works with unit case managers, clinical nurse managers, physicians, and social work to facilitate Interdisciplinary… more
- Mount Sinai Health System (New York, NY)
- …Master's degree preferred + 5 years of Case Management and 6 years as a clinical nurse . + Previous supervisory experience in case management or a related field. ... expected to engage internal and external stakeholders in the improvement of clinical case management, outcomes management processes and throughput. In the absence of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... subject matter expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems.* Consistently demonstrates high… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …peer-to-peer calls in timely manner and provides support for the Case Management (CM) and Registered Nurse ( RN ) reviewers and manages the denial process. + ... for you, we encourage you to apply! Job Description: The position provides clinical leadership and support for the development and implementation of the Children's… more
- Mount Sinai Health System (Long Island City, NY)
- …field **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience in Case Management or a ... field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions… more
- Catholic Health Services (Smithtown, NY)
- …Nursing (BSN) degree required Master of Science degree strongly preferred Licensure: New York Registered Nurse ( RN ) License & Registration Salary Range USD ... nursing supervisors will report to them. The Director of Care Management and Nurse Operations will: Work collaboratively with, but not limited to, Medical Staff,… more
- Premier Medical Group of the Hudson Valley (Poughkeepsie, NY)
- … (LPN) The LPN functions under the supervision and guidance of the Registered Nurse and Physician, participating in the multi-disciplinary process of providing ... care and treatment to patients. They will provide clinical support and technical assistance to the professional medical and other staff. The LPN is responsible for… more
- Guthrie (Corning, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... of coverage of ordered medications. * *Coordinate and complete appeals for denials as needed * *Monitor and Review...offices and for DBL office as needed Coverage for RN Nurse Navigator * *Coordinate and facilitate… more