- Mount Sinai Health System (New York, NY)
- …collaboratively with physicians and managed care companies on concurrent denial appeals 5. 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). 2. Obtains… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex ... Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) Plan leadership and… more
- 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
- Guthrie (Corning, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience in nursing, ... 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
- Humana (Albany, NY)
- …responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare members. You will also ... : Characterize the impactable drivers of prior authorization and look at appeals rate with denials and overturns. Deliver the upmost consistent medical director… 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
- Arnot Health (Elmira, NY)
- …errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to ... Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have proficient writing… more
- University of Rochester (Rochester, NY)
- …Under the direct supervision of the Practice Manager, Clinic Director and Nurse Manager works with considerable latitude for independent judgement. Responsible for ... in selecting for routine and non-routine letters of correspondence related to appeals on denied claims, billing and patient communications. + This includes compiling… more
- Catholic Health Services (West Islip, NY)
- …not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure ... Master of Science degree strongly preferred. Licensure: New York Registered Nurse (RN) License & Registration. Certification: Care Manager Certification (CCM)… more
- Stony Brook University (Stony Brook, NY)
- …facilities throughout the hospital stay. + Assist with coverage for UR, Appeals and denials + Actively involved in performance improvement activities including ... and other duties as required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license and working history of 5… more