- Constructive Partnerships Unlimited (New York, NY)
- …Interdisciplinary Treatment Team to ensure that all team members are aware of all medical conditions and care. 8. Review reports daily to ensure timely, ... and regulatory standards. 6. Participate with nursing management to review , update and develop policies and procedures for clinical...investigations and reviews. SUPERVISES : Nurse Educators Nurse Case Managers (NCM) Medical Case Manager… more
- Veterans Health Administration (East Orange, NJ)
- Summary The NJ VA Healthcare System (level 1c affiliated teaching medical center consisting of 11 sites; serving approximately 60,000 Veterans) is hiring for a Chief ... of the NJ VA Healthcare System. Videos Duties The Nurse IV QSV Chief functions as an advisor, administrator,...all levels of Veterans Integrated Services Network (VISN) and medical center personnel and relate effectively with customers, families,… more
- Community Medical and Dental Care Inc (Monsey, NY)
- …accurate and thorough documentation of all professional services rendered. Prepare and review reports, claims , and correspondence; ensure that records and ... Community Medical & Dental Care, Inc., is a non-profit...Care, is seeking an experienced Family, Pediatric, or Specialty, Nurse Practitioner. for a full-time or part-time position. We… more
- Community Medical and Dental Care Inc (Monsey, NY)
- …appropriate records relating to all professional services rendered. + Prepare and review reports, claims , and correspondences. Ensure that records and ... Co mmunity Medical & Dental Care, Inc., is a non-profit...Care, is seeking an experienced Family, Pediatric, or Specialty, Nurse Practitioner. for a full-time or part-time position. We… more
- Molina Healthcare (Yonkers, NY)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Elevance Health (Woodbridge, NJ)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- BronxCare Health System (Bronx, NY)
- …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Licensed Practical Nurse : Under the direct supervision of a physician...analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- Ankura (New York, NY)
- …how to research and access regulatory guidelines and reference materials + Conducts independent review of medical records - EMR (electronic medical records) ... paper documentation + Drafts clear and concise analyses of medical record review and coding findings +...Familiar with revenue cycle processes and facility and professional claims + Demonstrates excellent communication skills, both written and… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …and SCIP-R. 12. Reports all incidents to the Residence Manager, and reports all medical issues/ injuries to the registered nurse and follows protocols for ... individuals and arranges transportation as necessary. Upon instructions of the Nurse , accompanies individuals on medical appointments and/or visits hospital… more
- Molina Healthcare (Yonkers, 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
- BronxCare Health System (Bronx, NY)
- …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Under the direct supervision of a Registered Nurse or Physician, participate in providing patient care...for patients. Record patient's personal care and physical findings. Review discharge instructions with the patients and confirms that… more
- Community Medical and Dental Care Inc (Monsey, NY)
- …and thorough documentation of all professional services rendered. + Prepare and review reports, claims , and correspondence; ensure that records and documentation ... Co mmunity Medical & Dental Care, Inc., is a non-profit...Care, is seeking an experienced Family, Pediatric, or Specialty, Nurse Practitioner. for a full-time or part-time position. We… more
- Elevance Health (Woodbridge, NJ)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- City of New York (New York, NY)
- …compensability of treatment as it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and ... Compensation Division are responsible for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult… more
- Veterans Affairs, Veterans Health Administration (Bronx, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The James J. Peters VA Medical Center is recruiting for Full-Time Physician (Anesthesiology). The incumbent will be Board-Eligible or… more
- Mount Sinai Health System (New York, NY)
- …+ Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign healthcare ... Conducts Root Cause Analysis investigations, which includes assessing need for focused review by departments, and or clinical chairpersons for peer reviews. 5.… more
