- Terumo Medical Corporation (New York, NY)
- …Date: Oct 15, 2025 Req ID: 5263 Location: New York, NY, US Company: Terumo Medical Corporation Department: TIS Sales - New York Metro Terumo Medical Corporation ... (TMC) develops, manufactures, and markets a complete, solutions-based portfolio of high-quality medical devices used in a broad range of applications for numerous… more
- Molina Healthcare (Yonkers, NY)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Yonkers, NY)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Centene Corporation (New York, NY)
- … Licensure as well as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient ... beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary...necessity using appropriate criteria, referring those requests that fail review to the medical director for second… more
- Molina Healthcare (Yonkers, NY)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
- Centene Corporation (Queens, NY)
- …terminology such as ICD 10 codes, medical abbreviations, medications. Experience in medical records review , claims processing or utilization and case ... on workplace flexibility. **Position Purpose:** The Clinical Quality Assurance RN will work in various capacities to review...order to ensure that all components of the Member's medical record are completed with quality standards and accuracy… more
- Catholic Health Services (Smithtown, NY)
- …coding and billing of resident care services to maximize reimbursement. + Claim Review : Review and analyze submitted claims for accuracy and identify ... care center; 296-bed not-for-profit community hospital and a 60,000 square foot medical office building. Our nurses, physicians and support staff are devoted to… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …the Residence Manager, and reports all medical issues/ injuries to the registered nurse and follows protocols for notification. 13. Performs variety of ... reports and maintaining database of consumer health information after review and signed by the RN . +...+ Performs all other duties as assigned by the registered nurse . II. POSITION REQUIREMENTS A. Qualifications… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …medical issues with VP of Nursing, Nurse Administrator, Registered Nurse ( RN ), and Medical Coordinators2. Maintains medical records, including ... health recordse. As directed by the VP of Nursing/ Nurse Administrator debrides hard copy of medical ...stationery supplies.23. Perform data entry tasks accurately and efficiently. Review data for deficiencies or errors.24. Assist with special… more
- BronxCare Health System (Bronx, NY)
- …Licensed Practical Nurse : Under the direct supervision of a physician and/ or Registered Nurse , participates in the application of the nursing process to an ... (according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS… more
- BronxCare Health System (Bronx, NY)
- …and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate preferred . ... collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement… more
- Catholic Health Services (Melville, NY)
- …The ProFee CDS will focus on pre-visit provider support, post-visit provider review , and collaboration and education with providers. Pre-visit provider support - ... indicators + Validation of data-driven suspect diagnoses Post-visit provider review - Perform post-visit reviews focused on what is...other chronic conditions that are addressed as part of medical decision making and the treatment plan + Assesses… more
- RWJBarnabas Health (Oceanport, NJ)
- …set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained. Qualifications: Required: + Bachelor's degree ... Bachelor's degree. + Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with… more
- Mount Sinai Health System (New York, NY)
- …The Senior Risk Manager supports the Risk Management staff on how best to review risk management data, conduct Root Cause Analysis, and comply with risk management ... to develop educational plans for instructing staff about the medical center's activities and the daily administration of its...to the Risk Management staff on how best to review risk management data, conduct Root Cause Analysis, and… more
- RWJBarnabas Health (Oceanport, NJ)
- …set forth by RWJBH, American Hospital Association (AHA) and the American Medical Association (AMA) must be maintained. Qualifications: Required: + Bachelor's degree ... Bachelor's degree. + Extensive knowledge of ICD-10-CM/PCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with… more
- Catholic Health Services (Roslyn, NY)
- …actions plans + Responsible for professional liability discovery + Attends claims litigation meeting + Coordinates, investigates, trends and disseminates safety ... and Privacy programs including risk assessments and rounding + Conduct medical record reviews to identify potential regulatory concerns, quality issues, and… more
