- Terumo Medical Corporation (New York, NY)
- …Date: Oct 15, 2025 Req ID: 5263 Location: New York, NY, US Company: Terumo Medical Corporation Department: TIS Sales - New York Metro Terumo Medical Corporation ... (TMC) develops, manufactures, and markets a complete, solutions-based portfolio of high-quality medical devices used in a broad range of applications for numerous… more
- Molina Healthcare (Rochester, 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
- Cognizant (Albany, NY)
- …role expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full...semiannual basis or as indicated. + Coordinate with the Medical Case Manager Counselors (MCMC) to ensure medical ... NY, Yonkers, NY Apply Now (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services… more
- CVS Health (Albany, NY)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... virtual** **training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and...Mandates. + May be responsible for pricing, coding, researching claims to ensure accurate application of contract benefits and… more
- Molina Healthcare (NY)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… 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
- Sedgwick (Albany, NY)
- …providers to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Centene Corporation (Queens, NY)
- …terminology such as ICD 10 codes, medical abbreviations, medications. Experience in medical records review , claims processing or utilization and case ... on workplace flexibility. **Position Purpose:** The Clinical Quality Assurance RN will work in various capacities to review...order to ensure that all components of the Member's medical record are completed with quality standards and accuracy… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and appropriateness of care, ... Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical ...and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. +… more
- Trinity Health (Syracuse, NY)
- …strongly preferred). + Master's degree preferred. + Certification (CPHRM) is preferred. + Registered Nurse preferred. + Ideally, the candidate will have 3-5 ... for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have… more
- Catholic Health Services (Smithtown, NY)
- …coding and billing of resident care services to maximize reimbursement. + Claim Review : Review and analyze submitted claims for accuracy and identify ... care center; 296-bed not-for-profit community hospital and a 60,000 square foot medical office building. Our nurses, physicians and support staff are devoted to… more
- Sedgwick (Albany, NY)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior Medicare-set-aside (MSA) experience ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… 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
- CDPHP (Latham, NY)
- …on nationally recognized criteria and CDPHP policies, and procedures. QUALIFICATIONS: + Registered Nurse with a current New York State license required. ... to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the...years of acute care experience is required as a Registered Nurse . + Minimum of two (2)… 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
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …medical issues with VP of Nursing, Nurse Administrator, Registered Nurse ( RN ), and Medical Coordinators2. Maintains medical records, including ... health recordse. As directed by the VP of Nursing/ Nurse Administrator debrides hard copy of medical ...stationery supplies.23. Perform data entry tasks accurately and efficiently. Review data for deficiencies or errors.24. Assist with special… 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
