- Cognizant (Albany, NY)
- …need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact… 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 ... based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to...job entry date. Current License to practice as a Registered Professional Nurse in New York State… more
- Independent Health (Buffalo, NY)
- …standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse (RN) with active, current, unrestricted NYS license ... Trustworthy, Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal… more
- Molina Healthcare (Rochester, NY)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge… more
- Garnet Health (Middletown, NY)
- … Documentation Specialist (CCDS) credentialed * Current license to practice as a Registered Professional Nurse in New York State required. Physical Requirements: ... to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… 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
- Bassett Healthcare (Cooperstown, NY)
- …in a healthcare setting, preferred Licensure/Certifications: + Current NYS licensure as a Registered Professional Nurse , if applying as a nurse , required ... facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and… more
- Rochester Regional Health (Rochester, NY)
- …acute hospital care experience + Licensed in New York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management ... Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department (NYSED)New… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more
- Ellis Medicine (Schenectady, NY)
- …and assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, ... primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse ...information per policy. + Assists Utilization Management with initial clinical review requests as needed. + Notifies Case Manager… more
- Elderwood (Cheektowaga, NY)
- Salary $38 - $49.50 per hour 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...for pre and post-pay record reviews, ADR requests and appeals processes. + Manages NYS RUGs III case mix… more
- Catholic Health Services (West Islip, NY)
- …required. + Master of Science degree strongly preferred. + Licensure: New York Registered Nurse (RN) License & Registration. + Certification: Care Manager ... not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure… more
- Calvary Hospital (Bronx, NY)
- …year Requirements QUALIFICATIONS: 1. Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15) years ... to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts… more