- Cognizant (Albany, NY)
- …, and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews .… more
- Independent Health (Buffalo, NY)
- …a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document research of ... benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical Reviewer will be responsible for the collection and review… 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 ... **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… 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
- 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...and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health… more
- Northwell Health (Melville, NY)
- …plus specialized certifications as needed. Preferred Skills 3-5 years experience in Utilization Review , Case Management, and Clinical Appeals . 3-5 years of ... stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately… more
- Molina Healthcare (Rochester, NY)
- …set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill… 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
- 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). ... plan of care and coordination of services based on clinical needs and available resources. + Utilization Review...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… 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 ... The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case… more