- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and ... to best respond to all hospital denials notification and documentation efforts. The Appeals Manager will provide timely tracking and trending of all denials… more
- Healthfirst (NY)
- …and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** + **Lead ... but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner… more
- Calvary Hospital (Bronx, NY)
- …reimbursement and quality issues. 16. Communicates identified issues relating to quality, utilization , risk and discharge planning to the Department Director. ... The RN Case Manager (RNCM) will be responsible for all aspects...length of stay (ELOS). The RNCM participates in the Utilization Review, Discharge Planning, Risk Management, and Quality Assessment… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Crouse Hospital (Syracuse, NY)
- …day management of the RN Care Managers in the department , including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing ... Crouse's Care Coordination team is hiring a Care Coordination Manager who is responsible for providing day to day...day management of the RN Care Managers in the department . Pay Range: $95,000 plus based on education and… more
- Molina Healthcare (Albany, NY)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department . We are seeking a Registered Nurse with ... modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level III (in ... assigned to non-care managers are monitored by the care manager + The care manager provides feedback...under pressure. + Demonstrates proficiency in basic navigation and utilization of department specific applications: care management… more
- Catholic Health Services (West Islip, NY)
- …Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and ... is responsible for providing overall management of the Care Coordination department responsible for patient care coordination, including oversight of Managers of… more
- WMCHealth (Valhalla, NY)
- …Provider Solutions Inc. City/State: Valhalla, NY Category: Clerical/Administrative Support Department : Health Info Mgmt-WMC Health Union: No Position: Per Diem ... Job Details: Job Summary: The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the… more