- Molina Healthcare (Buffalo, 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 (Buffalo, NY)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… more
- Molina Healthcare (Buffalo, NY)
- …quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review , or equivalent combination of relevant ... validation tools and process improvements - ensuring that member medical claims are settled in a timely...education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Buffalo, NY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more
- Molina Healthcare (Buffalo, 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 (Buffalo, 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 (Buffalo, 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
- Independent Health (Buffalo, NY)
- …**Overview** The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals ... document research of initial coverage determinations, and lead coordination of clinical review with appropriate internal stakeholders and Medical Director. This… more
- Independent Health (Buffalo, NY)
- …database. + Provide high quality, professional utilization management services: ( medical necessity review for Prior Authorization, pre-certification, and ... with designated turnaround time. + Clear documentation of clinical information for medical necessity review of all requests, procedures, admissions, and… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... for delivery of primary care to patients enrolled at the WNY VA Medical Center at the Community Living Centers. The geriatrician will work in collaboration… more
- Catholic Health (Buffalo, NY)
- …for the people, carrying out and documenting the appeals process for denied claims denied due to reasons including, but not limited to clinical documentation/support ... for diagnostic related grouping (DRG) assignment, inpatient and outpatient medical necessity. The individual also works to maintain third-party payer relationships.… more