- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- Elevance Health (New Hyde Park, NY)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...including ensuring accurate entry, investigation, and analysis of state appeals ; summarizing medical information for review by… 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...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... Overview The Appeals Manager is responsible to assist in the...for timely response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse … more
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective utilization management… more
- Rochester Regional Health (Rochester, NY)
- …+ Prepare the UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an appeal has been initiated or no ... Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General...minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical… more
- Crouse Hospital (Syracuse, NY)
- …department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission prevention, length ... of stay and daily review of observation admissions. + Works with Business Office...Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +… more
- Catholic Health (Buffalo, NY)
- …and mentoring Utilization Review , Clinical Documentation Integrity and Clinical Denials and Appeals teams. They ensure the teams receive comprehensive ... care team and works in conjunction with the Utilization Review Manager and Manager Clinical Documentation Integrity....+ Bachelor of Science Nursing (BSN) degree + Registered Nurse with a current New York State license CERTIFICATION… more
- Molina Healthcare (Albany, NY)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible… more
- Elevance Health (New York, NY)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical...and supportive care. + Perform physician-level case review , following initial nurse review ,… more