- 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
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process… more
- Arnot Health (Elmira, NY)
- …Auth/Denial Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have ... errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive manner to… more
- Independent Health (Buffalo, NY)
- …(CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN or LPN ... coding complexity. They will aid in training other team members, evaluating appeals , and share audit trends across the team. Expertise and proficiency demonstrated… more
- Ellis Medicine (Schenectady, NY)
- …and assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, ... primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse ...or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data entry of… more
- Calvary Hospital (Bronx, NY)
- …year Requirements QUALIFICATIONS: 1. Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15) years ... to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts… more
- Guthrie (Corning, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... of coverage of ordered medications. * *Coordinate and complete appeals for denials as needed * *Monitor and Review...offices and for DBL office as needed Coverage for RN Nurse Navigator * *Coordinate and facilitate… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... other functions as assigned by management. Minimum Qualifications: + RN with valid and current NYS Nursing Licensure. +...not limited to UM and CM, Fair Hearings and Appeals /Grievances, within three months of working in position. +… more
- Saratoga Hospital (Saratoga Springs, NY)
- …and documents, entering data into the EMR system, assisting in compiling appeals and reconsiderations. + Collaborate and communicate effectively with employees and ... lieu of experience. + Appropriate certification or licensure for the role (eg RN , LPN, CNA, administrative roles, etc.). + Strong communication and teamwork skills.… more