- Molina Healthcare (Albany, NY)
- … appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of ... these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Centene Corporation (New York, NY)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... hiring a Manager who is responsible for providing day to day management of the RN Care Managers in the department. Pay Range: $95,000 plus based on education and… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- Catholic Health Services (West Islip, NY)
- …(BSN) degree required. Master of Science degree strongly preferred. Licensure: New York Registered Nurse ( RN ) License & Registration. Certification: Care ... not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN /Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... or a minimum of 3-5 years experience as a RN in an acute care setting. Licensing and Certification...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** RN /Case Manager Mount Sinai West FT Days 8a-4p EOW The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... or a minimum of 3-5 years? experience as a RN in an acute care setting. + Current NYS...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
- Guthrie (Binghamton, NY)
- …to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . Assesses and coordinates discharge planning needs with ... healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations The pay range for this position… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …peer-to-peer calls in timely manner and provides support for the Case Management (CM) and Registered Nurse ( RN ) reviewers and manages the denial process. + ... Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) Plan leadership and… more
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