- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...hospital setting, including at least 1 year of utilization review , medical claims review… more
- Molina Healthcare (Albany, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Cognizant (Albany, NY)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical… more
- Evolent (Albany, NY)
- …+ Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review determinations and contacts ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Sedgwick (Albany, NY)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior Medicare-set-aside (MSA) experience highly ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Lincoln Financial (Albany, NY)
- …mental health disability claims . You will act as a resource to review , analyze, and interpret medical information as well as assess ongoing interventions ... Protection Clinical organization. You will collaborate with Independent Consulting Physicians, Claims Specialists, and Nurse Disability Consultants to assist… more
- GE Vernova (Schenectady, NY)
- …responsible for analyzing Projects risk to develop mitigation plans and support claim development / resolution. Project Controller is also responsible to perform an ... based on allocated weightage + Participate in the Constructability review to make sure project schedule is aligned with...deliverables and ensure no impact to contract dates. + Claims (EOT, etc.); perform delay analysis to support extension… more
- GE Vernova (Schenectady, NY)
- …project execution and ensures that commercial risks and opportunities (notably claims , change orders, vendor and insurance recoveries) are identified early, tracked, ... as negotiation. **Job Description** + Implement risk mitigation strategies + Develop claims settlement agreements + Manage and drive Contract Change Order execution… more
- Molina Healthcare (Albany, NY)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Albany, NY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Molina Healthcare (Albany, NY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- GE Vernova (Schenectady, NY)
- …the purchase orders within budget * Supports Commodity Manager in contract claim management and ensures vendor recovery * Supports GCL/CSL/Buyer in invoices release, ... participation of project quality manager, PEM, lead engineers, scheduler and PM/PD to review procurement progress and generates the weekly PO progress review … more
- Cardinal Health (Albany, NY)
- …Operations Management oversees the business and administrative operations of a medical practice. Managed Care oversees the interactions that take place between ... an active credentialing status with all contracted payors for all Centers, Nurse Practitioners and employed physicians. The position is also responsible for ensuring… more