- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews ... for additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as required. +… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors ... advisors and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with all insurance and regulatory… more
- Catholic Health (Buffalo, NY)
- …role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out and documenting ... the appeals process for denied claims denied due to reasons...payers) and internal stakeholders including, but not limited to, Utilization Review, Case Management, Clinical Documentation Integrity, Health Information… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements… more
- Molina Healthcare (Yonkers, NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Molina Healthcare (Yonkers, NY)
- …expert. * Ensures Molina is compliant with the coverage determination and appeals process. * Contributes to projects aimed at improving STAR ratings, Healthcare ... initiatives under the direction of leadership. * Monitors drug utilization and assists leadership team in understanding quality and...care team (ICT). * Works with the Pharmacy Benefit Manager (PBM) to manage formulary changes and update marketing… more
- Mount Sinai Health System (New York, NY)
- …homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + Manager or a minimum of 3-5 years? experience as a ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- CUNY (Brooklyn, NY)
- …early intervention student support service process, the resolution of student grievances, appeals , and complaints, and the utilization of the Behavioral ... Manager of Student Advocacy and Accountability (HEA) **POSITION...conduct reports; coordinating the student conduct process, grievances, and appeals . + Oversee the Faculty Student Disciplinary Committee to… more
- Bassett Healthcare (Cooperstown, NY)
- …and reporting of resources and financial indicators including LOS, excess days, resource utilization , denials and appeals , swing bed statistics. + Uses data to ... and enjoy the best quality of life possible. What you'll do The Case Manager RN supports the physician and interdisciplinary team in facilitating patient care, with… more
- Elevance Health (New Hyde Park, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Manager , Medical Director - Transformation Initiatives** Location: This...of Care / Payment Integrity** + **Care Management / Utilization Management (CM/UM) Modernization** + **Provider Networking & Modernization**… more
- Amgen (New York, NY)
- …us and transform the lives of patients while transforming your career. **Field Reimbursement Manager - New York Metro** **What you will do** Let's do this. Let's ... change the world. In this vital role the Field Reimbursement Manager (FRM) will manage defined accounts within a specified geographic region for Patient Access and… more
- City of New York (New York, NY)
- …hearings by mail, web, and mobile app. In addition, the judges hear appeals of parking ticket determinations, and a special unit for Commercial Adjudications ... conducts hearings and appeals on tickets issued to commercial vehicles. The Customer...Analyst (Non-Managerial Level 2) to serve as the Operations Manager for the STARS Modernization Project. The selected candidate… more
- Arnot Health (Elmira, NY)
- …errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to ... in nursing preferred. Must have proficient writing skills.Experience in Utilization Review and InterQual required. CARDIOPULMONARY RESUSCITATION (CPR) REQUIREMENTS:… more
- Ellis Medicine (Schenectady, NY)
- …Planner's primary function is to work with the Social Worker, Nurse Case Manager , or Utilization Management Nurse to facilitate patient discharge plans, support ... Conditions of Participation at the direction of the Case Manager . + Utilization Management Activities: + Collaborates...or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data entry of… more
- Molina Healthcare (Rochester, NY)
- … Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. + ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more
- Ellis Medicine (Schenectady, NY)
- …beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . * Utilization Management Activities; Collaborates with Case Managers and ... to make post discharge arrangements for patients. Assists Case Manager or Social Worker by offering choice of providers....other team members for optimal Utilization Management information throughout the continuum. Maintains relationships with… more
- Molina Healthcare (Rochester, NY)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Catholic Health Services (West Islip, NY)
- …Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and ... Hospital Conditions of Participation. + Implements care management programs, including utilization review, intake and discharge planning. + Evaluates patient care… more
- Elevance Health (New York, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... not required for posting. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical program and/or independently… more
- University of Rochester (Rochester, NY)
- …**Responsibilities:** GENERAL PURPOSE Under the direct supervision of the Practice Manager , Clinic Director and Nurse Manager works with considerable ... the time and effort of providers by reviewing reports such as Clinic Utilization , Master Templates and the volume of Referrals. + Develops, enforces and continuously… more