- Elevance Health (Latham, NY)
- **Nurse Case Manager II ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... from 11:30 AM to 8:00 PM EST. The **Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care… more
- Elevance Health (Latham, NY)
- **Telephonic Nurse Case Manager II ** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II ** is responsible...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …policies and procedures and related health plan functions such as member services, claims , and the referral process. As well as functions related to legislative and ... the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates and utilizes corporate applications; core claims… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …compliance and regulatory requirements. Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- WMCHealth (Poughkeepsie, NY)
- …lawsuit, etc.) and alerts the department director, medical staff leadership, and claims manager . + Conducts special studies in collaboration with medical ... a potential lawsuit, etc.) and alerts the department director, administration, and the claims manager . Initiates a more thorough review to clarify the… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …is on-site in the residence. + Reports any concerns/discrepancies to the nurse case manager . Ensures all over-the counter medications are not expired and ... and SCIP-R. 12. Reports all incidents to the Residence Manager , and reports all medical issues/ injuries to the...all other duties as assigned by the registered nurse. II . POSITION REQUIREMENTS A. Qualifications 1. Must have a… more
- Trinity Health (Syracuse, NY)
- …ENVIRONMENT AND HAZARDS:** Office and/or Clinical Setting. Exposure Class I or II - dependent on service. **PHYSICAL DEMANDS:** Sedentary work: requires sitting, ... visitors, vendors, various regulatory and professional agencies. **SUPERVISED BY:** Manager of Risk Management **SUPERVISES:** None **CAREER PATH:** Management… more