- 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
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full...semiannual basis or as indicated. + Coordinate with the Medical Case Manager Counselors (MCMC) to ensure medical ... NY, Yonkers, NY Apply Now (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services… 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
- 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
- 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
- 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
