- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Clinical Review and Coding Nurse is responsible to attain procedure and diagnosis ... and consistency on referred cases. The RN will perform and coordinate the clinical component of the provider appeal function including communication of the decision… more
- Fresenius Medical Center (Troy, NY)
- …and auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding . + Manages clinic ... **About this role:** As a Clinical Manager with Fresenius Medical Care, you will...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- CDPHP (Albany, NY)
- …The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services requiring prior authorization. This includes ... reviews for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and inpatient… more
- Elevance Health (Latham, NY)
- ** Nurse Audit Lead** **Supports the Carelon Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). The ideal ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Nurse Audit Lead** is responsible for leading a team of clinicians… more
- CDPHP (Albany, NY)
- …to be a part of that experience. The Medicaid Special Programs Registered Nurse Assessor/Case Manager is responsible for conducting the initial and reassessments for ... to meet the member's needs. The Medicaid LTSS Registered Nurse Assessors are expected to use critical thinking and...Assessors are expected to use critical thinking and sound clinical judgement when making recommendation for proposed services and… more
- CDPHP (Albany, NY)
- …members, employees, or informants, utilize data mining and conduct medical record review to identify suspicious trends and patterns and enrollment and billing ... basis of fraud, waste, or abuse. QUALIFICATIONS: + Professional clinical license valid in New York State, such as...license valid in New York State, such as Registered Nurse , Licensed Practical Nurse , Pharmacist, Mental Health… more