- Cognizant (Albany, NY)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… 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
- 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
- Molina Healthcare (Rochester, NY)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing… 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