• Telephonic Nurse Case Manager…

    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
    Elevance Health (09/11/25)
    - Related Jobs

  • Medical Investigator I/ II

    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
    Excellus BlueCross BlueShield (09/17/25)
    - Related Jobs

  • Utilization Manager Reviewer, RN (Multiple…

    Excellus BlueCross BlueShield (Rochester, NY)
    …to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as required, ... explaining processes for accessing Health Plan to perform medical review, obtains case or disease management support, or otherwise interacts with Health Plan… more
    Excellus BlueCross BlueShield (08/23/25)
    - Related Jobs

  • Coding Auditor Educator-Inpatient

    Highmark Health (Albany, NY)
    …coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure ... + Validates the ICD-CM, ICD-PCS, CPT and HCPCS Level II code and modifier systems, missed secondary diagnoses and...works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs… more
    Highmark Health (09/20/25)
    - Related Jobs

  • Residence Counselor Medical Coordinator

    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
    Constructive Partnerships Unlimited (09/02/25)
    - Related Jobs

  • Healthcare Risk Management - St Peters Health…

    Trinity Health (Albany, 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
    Trinity Health (07/22/25)
    - Related Jobs