- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the...companies on concurrent denial appeals e. Communicates clinical information to the payor, as needed, coordinating direct… more
- Mount Sinai Health System (Long Island City, NY)
- …field **Experience Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience in Case Management or a ... will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process… more
- Molina Healthcare (Syracuse, NY)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Bassett Healthcare (Cooperstown, NY)
- …facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and ... methodologies in evaluating outcomes of care + Support and coaching of clinical documentation efforts + Coordinating communication with physicians Must be able to… more
- Guthrie (Binghamton, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience preferred in ... state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient...of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor and Review… more
- Guthrie (Corning, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience in nursing, ... state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient...of coverage of ordered medications. * *Coordinate and complete appeals for denials as needed * *Monitor and Review… more
- Ellis Medicine (Schenectady, NY)
- …The Discharge Planner's primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge ... in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, updating… more
- Rochester Regional Health (Rochester, NY)
- …as a liaison between hospital and payors, ensuring accurate communication of clinical information, supporting appeals , and optimizing benefit use. + Collaborates ... by modeling the Brand Promise and Core Values. RESPONSIBILITIES: + Conducts clinical reviews using Interqual criteria to determine appropriate patient level of care,… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of ... In this role, you will be responsible for evaluating and responding to clinical and administrative denials referred to Case Management Department for appeal. You… more
- Elderwood (Cheektowaga, NY)
- Salary $38 - $49.50 per hour Overview Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself an expert in assessment and reimbursement ... of Benefits Program + Increased Tuition Reimbursement Program for Clinical Tracks + Shift Differentials + Full Benefits Package...for pre and post-pay record reviews, ADR requests and appeals processes. + Manages NYS RUGs III case mix… more