- Molina Healthcare (Albany, NY)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that ... to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- MVP Health Care (Schenectady, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... passion for patient-centered advocacy, clinical precision and regulatory compliance this is an opportunity...UM platforms. + Familiarity with CMS regulations and appeals processes. + Ability to work independently and manage… more
- Molina Healthcare (Albany, NY)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Albany, NY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are… more
- MVP Health Care (Schenectady, NY)
- …York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 ... maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals ...+ Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines.… more