- Molina Healthcare (Yonkers, 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
- New York State Civil Service (New York, NY)
- NY HELP No Agency Attorney General, Office of the Title Legal Nurse | Review Medical Malpractice Claims for NYS (6402) Occupational Category Legal Salary ... to the Claims Bureau will analyze and review claims containing allegations of medical...and be registered to practice as a registered professional nurse or licensed physician in New York state. It… more
- Travelers Insurance Company (Morristown, NJ)
- …law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through ... of up to $2,000. This position handles First Party Medical Litigation or Arbitration claims from the...facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Travelers Insurance Company (Morristown, NJ)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- BronxCare Health System (Bronx, NY)
- …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Licensed Practical Nurse : Under the direct supervision of a physician...analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- Elevance Health (Morristown, NJ)
- **Telephonic RN Nurse Case Manager I** **Sign On Bonus: $3000** **Location: This role enables associates to work virtually full-time, with the exception of required ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager I** is responsible for performing care management within… more
- Molina Healthcare (Yonkers, 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
- City of New York (New York, NY)
- …compensability of treatment as it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and ... Compensation Division are responsible for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult… more
- Mount Sinai Health System (New York, NY)
- …for reviewing, summarizing, analyzing, presenting and monitoring safety events, claims management, loss prevention and reduction, patient safety related quality ... + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign healthcare… more
- BronxCare Health System (Bronx, NY)
- …projects 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