- 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
- Molina Healthcare (Rochester, NY)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for 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
- Guthrie (Binghamton, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience preferred in ... state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient...of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor and Review… more
- Highland Hospital (Rochester, NY)
- …+ Complete clinical documentation, forms/paperwork requested by patients, prior authorization appeals , sign home care orders + Coordinate with other providers, home ... Requirements:** 1. Education: Fulfills the requirements to be licensed as a Nurse Practitioner in NYS 2. Experience: Home care, hospice/palliative care, inpatient… 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 of high ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Catholic Health (Buffalo, NY)
- …mentoring Utilization Review, Clinical Documentation Integrity and Clinical Denials and Appeals teams. They ensure the teams receive comprehensive education on ... vital. Responsibilities: EDUCATION + Bachelor of Science Nursing (BSN) degree + Registered Nurse with a current New York State license CERTIFICATION + Holds, or will… more
- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... QUALIFICATIONS: 1. Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15) years of management… more
- Garnet Health (Middletown, NY)
- …the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, policies and procedures ... within 6 months * Current license to practice as a Registered Professional Nurse in New York State required. Physical Requirements: Travel to multiple facilities is… more