- Cognizant (Albany, NY)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- Evolent (Albany, NY)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate… more
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... license.** **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing… more
- Catholic Health (Buffalo, NY)
- …with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the ... people, carrying out and documenting the appeals process for denied claims denied due to reasons...denied due to reasons including, but not limited to clinical documentation/support for diagnostic related grouping (DRG) assignment, inpatient… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to...date. Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document… more
- Molina Healthcare (Rochester, NY)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems. +...not limited to UM and CM, Fair Hearings and Appeals /Grievances, within three months of working in position. +… more
- Garnet Health (Middletown, NY)
- …rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. Responsibilities ... Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status… more