- 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 ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- FlexStaff (Poughkeepsie, NY)
- …medications are available and administered by AMAP-certified staff as ordered. 16. Review and edit the medication record to ensure the medications are transcribed ... learning in the timeframe assigned REQUIREMENTS: 1. Maintain current NYS Registered Nurse license - Graduation from an accredited nursing program - Bachelor's Degree… more
- Travelers Insurance Company (Melville, NY)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants nurse ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim life cycle… more
- Molina Healthcare (Rochester, NY)
- …experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- Sedgwick (Albany, NY)
- …and investigates cases accordingly. + Interviews practitioners involved in medical malpractice claims . + Participates in follow-up review and investigation as ... PURPOSE OF THE ROLE:** Investigate, analyze and evaluate medical malpractice claims to assess liability issues and exposure. Reviews medical records, interviews… more
- Sedgwick (Albany, NY)
- …and assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug ... team on difficult cases. + Consults with pharmacy UR team for difficult claims requiring weaning schedule. + Assesses needs, gives appropriate clinical options, and… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …Residence Manager, and reports all medical issues/ injuries to the registered nurse and follows protocols for notification. 13. Performs variety of miscellaneous ... in the residence. + Reports any concerns/discrepancies to the nurse case manager. Ensures all over-the counter medications are...reports and maintaining database of consumer health information after review and signed by the RN. + Completes clinic… more
- Elevance Health (Latham, NY)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical… more
- City of New York (New York, NY)
- …to the claimant's work injury and assist with medical case management of claims . Review and process high value and complicated in-patient billing. Coordinate ... for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult managerial and legal staff in regards to… more
- Constructive Partnerships Unlimited (Staten Island, NY)
- …meetings and as needed with all shifts of Direct Care Counselors, Nurse , and Clinical Team. 5. Responsible for scheduling all annual medication re-certifications ... with the Nurse Case Managers or designated RN's and ensuring documentation...personal funds, household monies, and recreation funds. Completes monthly review and sign-off of each of the above notes… more