• Quality Control Case Reviewer

    City of New York (New York, NY)
    …for (1) one Principal Administrative Associate II to function as a Quality Control Case Reviewer , who will: - Conduct the preliminary monthly review ... the review sample by conducting preliminary WMS inquiries and case review ; utilize reports to verify that sample is auditable; identifies inconsistencies,… more
    City of New York (08/13/25)
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  • CA Pert Sr Case Reviewer

    City of New York (New York, NY)
    …the final report. CA PERT Sr. Reviewer prepares lawsuit packets for each case in the review for electronic transmission to NYC Corporation Counsel. - Conduct ... during customer interaction, and determine whether appropriate action was taken. - Review case file information, POS entries and WMS data to report on the… more
    City of New York (08/13/25)
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  • NCA Pert Case Reviewer

    City of New York (New York, NY)
    …for (1) one Principal Administrative Associate II to function as a NCA PERT Case Reviewer , who will: - Conduct NCA Supplemental Nutrition Assistance (SNAP) ... customer interaction and determine whether appropriate action was taken. - Review case file information, Paperless Office System (POS) entries and Welfare… more
    City of New York (08/13/25)
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  • Senior Case Reviewer

    City of New York (New York, NY)
    …is recruiting for (1) one Principal Administrative Associate, who will function as a Senior Case Reviewer who will: - Conduct legally mandated case reviews ... THE PRINCIPAL ADMINISTRATIVE ASSOCIATE CIVIL SERVICE TITLE. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with… more
    City of New York (08/09/25)
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  • EIS Case Reviewer

    City of New York (New York, NY)
    …be eligible for continued employment. The Office of Constituent Services /Ombudsman Case Reviewer within the Medicaid Eligibility Information Services (EIS) is ... /Ombudsman is seeking two (2) Eligibility Specialist II's to function as EIS Case Reviewers who will: - Respond to inbound and outbound telephone calls received… more
    City of New York (08/13/25)
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  • Quality Control Case Reviewer

    City of New York (New York, NY)
    …for (2) two Principal Administrative Associates II to function as a Quality Control Case Reviewers, who will: - Review POS, HRA One Viewer of imaged/scanned ... to ensure that data collected is complete, accurate and appropriate to the case under review . - Prepare manual budgets to replicate the actual amounts issued to… more
    City of New York (08/13/25)
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  • CA Pert Senior Case Reviewer

    City of New York (New York, NY)
    …legal and federal, state and city regulatory requirements. The Process Evaluation Review Team (PERT) is tasked with aggressively monitoring program compliance with ... Assurance & Fiscal Integrity (OQA&FI) / The Process Evaluation Review Team (PERT) is recruiting for (2) one Principal...one Principal Administrative Associates III, to function as Senior Case Reviewers who will: - Conduct legally mandated … more
    City of New York (08/13/25)
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  • HEDIS Clinical Reviewer I (Seasonal)

    Excellus BlueCross BlueShield (Rochester, NY)
    …their home office. Essential Accountabilities: Level I + Conducts medical record review based upon standards outlined in department training manual + Retrieves, ... a minimum of two years of extensive medical record review experience + Electronic Medical Record/Electronic Health Record experience...3 years progressive HEDIS experience as per diem clinical reviewer . + Recognized as a HEDIS, QARR, and QRS… more
    Excellus BlueCross BlueShield (09/03/25)
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  • Utilization Manager Reviewer , RN (Multiple…

    Excellus BlueCross BlueShield (Rochester, NY)
    …by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address ... explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts with Health… more
    Excellus BlueCross BlueShield (08/23/25)
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  • Registered Nurse Quality & Patient Safety…

    Catholic Health (Buffalo, NY)
    …Must possess strong interpersonal skills necessary to work with medical staff, case management, patient care services, ancillary and support departments + Strong ... critical thinking, analytical and problem solving skills WORKING CONDITIONS + Must be flexible and demonstrate ability to adapt to stressful work environment REQNUMBER: 38071 more
    Catholic Health (07/19/25)
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