- Molina Healthcare (Syracuse, 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 (Syracuse, 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
- Molina Healthcare (Syracuse, 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 (Syracuse, 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 (Syracuse, 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
- Chobani (Rome, NY)
- …on risk mitigation strategies Responsibility for injury/incident management including claim reporting, investigations and root cause analysis During construction ... control to limit the financial impact to the company. Attend FATs and design review meetings to ensure Chobani EHS standards are met will regards to equipment,… more
- Trinity Health (Syracuse, NY)
- …for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have ... preferred). + Master's degree preferred. + Certification (CPHRM) is preferred. + Registered Nurse preferred. + Ideally, the candidate will have 3-5 years in risk… more