- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization / appeals management review. + Assist Utilization and Appeals Manager in setting up communications with payors ... advisors and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with all insurance and regulatory… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...+ Requests or provides Medical Records as required for appeals , On / Off-site Insurance reviews + Implements… more
- Molina Healthcare (Yonkers, NY)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Case Manager , Medicaid Long Term Support Program** to join #TeamMVP. If you have a ... **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes assessment, planning,… more
- Elevance Health (New Hyde Park, NY)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ** Manager , Medical Director - Transformation Initiatives** Location: This...of Care / Payment Integrity** + **Care Management / Utilization Management (CM/UM) Modernization** + **Provider Networking & Modernization**… more
- Amgen (New York, NY)
- …us and transform the lives of patients while transforming your career. **Field Reimbursement Manager - New York Metro** **What you will do** Let's do this. Let's ... change the world. In this vital role the Field Reimbursement Manager (FRM) will manage defined accounts within a specified geographic region for Patient Access and… more
- Molina Healthcare (Yonkers, NY)
- … utilization management, chief medical officers, physicians and member/provider inquiries/ appeals . * Provides training and support to clinical peers. * Identifies ... with knowledge of CPT/HCPCS codes, record review, chart audit, provider disputes, appeals , and 1500 & UB04 claim experience are highly preferred. Ability to… more
- Molina Healthcare (Yonkers, NY)
- … Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. + ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more
- Molina Healthcare (Yonkers, NY)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Catholic Health Services (West Islip, NY)
- …Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and ... Hospital Conditions of Participation. + Implements care management programs, including utilization review, intake and discharge planning. + Evaluates patient care… more
- Elevance Health (New York, NY)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit** **Management/ Utilization ** **Review** **Virtual:** This role enables associates to ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical… more
- Elevance Health (New York, NY)
- …for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of company ... Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions listed above. + Conduct… more