- Molina Healthcare (Syracuse, NY)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… more
- MVP Health Care (Rochester, NY)
- …you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 months after ... hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a...with an established interdisciplinary team. + The role requires review of a comprehensive assessment and development of a… more
- Guthrie (Binghamton, NY)
- …and complete appeals for denials as needed + Monitor and Review REMS clearance for monthly refills of high-risk medications ordered for patients Monitor ... monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years'...and Outgoing + Sick calls - collect data for review , assessment and instruction from RN or Provider +… more
- Guthrie (Corning, NY)
- …and complete appeals for denials as needed * *Monitor and Review REMS clearance for monthly refills of high-risk medications ordered for patients Monitor ... monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years'...and Outgoing * *Sick calls - collect data for review , assessment and instruction from RN or Provider *… 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
- Ellis Medicine (Schenectady, NY)
- …communicates confidential information per policy. + Assists Utilization Management with initial clinical review requests as needed. + Notifies Case Manager of ... primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse ...or send for insurance denials or quality improvement organization appeals . + Assists UM Coordinator with data entry of… 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
- Catholic Health Services (West Islip, NY)
- …not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure ... the most advantageous clinical and financial outcomes. + Supports all CH and...of Participation. + Implements care management programs, including utilization review , intake and discharge planning. + Evaluates patient care… more
- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... interdepartmental meetings related to the quality and utilization of clinical services. Serves on various Hospital committees as assigned. Attends meetings and… more