- Molina Healthcare (New York, NY)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...denied cases in which a formal appeals request has been made or upon request by… more
- Evolent (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… more
- Evolent (Trenton, NJ)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Centene Corporation (New York, NY)
- …**Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Atlantic Health System (Union, NJ)
- + Monday-Friday, 8:30 AM - 4:30 PM + 3 providers -2 MDs and 1 Nurse Practitioner + Summit and Morristown Seeking a detail-oriented nurse with experience in ... medication and imaging prior authorizations, appeals management, and completion of disability forms. The ideal candidate will be proficient in initiating and… more
- BelovED Community & Empowerment Academy Charter Sc (Jersey City, NJ)
- …three campuses, an Elementary School, Middle School, and High School. We are hiring a School Nurse to serve all of our students. You will be working on a team fo 4 ... Jersey City, Hoboken and New York City. If this appeals to you, then apply today! We have achieved...Jersey. Requirements + The Candidate needs to possess School Nurse certification in New Jersey. (We would consider someone… more
- Molina Healthcare (New York, NY)
- …responsibilities will include specialized medical necessity reviews and/or appeals and supporting market performance. Performance activities include physician ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Sharecare (Trenton, NJ)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals + Communicates clinical information to the payor, as needed, coordinating ... assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). + Obtains… more
- Molina Healthcare (New York, NY)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as needed, coordinating ... assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). b. Obtains… more
- Mount Sinai Health System (New York, NY)
- …degree preferred + 5 years of Case Management and 6 years as a clinical nurse . + Previous supervisory experience in case management or a related field. + Name: ... ensure appropriateness of admissions and proper reimbursement. 11. Ensures Discharge Appeals functions are carried out within contractual, federal and state… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Work with insurance carriers and MSKCC billing departments to initiate appeals and acquire authorizations for treatment Key Qualifications: + Current NYS ... Registered Nurse License/Registration and BSN preferred + At least 2-3 years of clinical hospital nursing experience + Managed care/UR/CM experience strongly… more
- Hackensack Meridian Health (North Bergen, NJ)
- …information to insurance company, billing certifications, concurrent managed care denial appeals and retrospective medical record utilization reviews. + Obtains and ... management **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. + AHA Basic Health Care Life Support HCP Certification.… more