- Public Consulting Group (Albany, NY)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels...Proven working experience in case management, including as a nurse , medical, mental health care manager or a related… more
- Arnot Health (Elmira, NY)
- …Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and ... billing clerks and management. 6. Follow up on denial claims using reports to ensure completion of appeal with...and other Arnot Health departments in matters of auth/denial review decisions. 8. Maintains a working relationship with Physician… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex ... and PH care across the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. + Collaborates with Provider Relations staff to ensure an… more
- Molina Healthcare (Albany, NY)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- GE Vernova (Schenectady, NY)
- …to Customs. + Active engagement of pre and post shipment audit review , inclusive of valuation, classification, country of origin and applicable special program ... Conduct internal training specific to Customs operations. + Support active review and revisions of business policies, procedures and manuals associated with… more
- Trinity Health (Albany, NY)
- …for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have ... is strongly preferred). Master's degree preferred. Certification (CPHRM) is preferred. Registered Nurse preferred. Ideally, the candidate will have 3-5 years in risk… more
- Mount Sinai Health System (New York, NY)
- …+ Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign healthcare ... Conducts Root Cause Analysis investigations, which includes assessing need for focused review by departments, and or clinical chairpersons for peer reviews. 5.… more
- Community Medical and Dental Care Inc (Monsey, NY)
- …and thorough documentation of all professional services rendered. + Prepare and review reports, claims , and correspondence; ensure that records and documentation ... Medical and Dental Care, is seeking an experienced Family, Pediatric, or Specialty, Nurse Practitioner. for a full-time or part-time position. We offer a very… more