- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… 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 ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- FLACRA (Clifton Springs, NY)
- Utilization Management Specialist FLACRA Clifton Springs, NY (Onsite) Full-Time $16.50 - $17.50/Hour Apply Now ... (https://flacra.jobs.net/apply/jqn6gn6t2h294xv9ngh?ipath=CR¬ify=true&siteid=cbnsv) Job Details Job Title:Utilization Management Specialist Location:Finger Lakes Region, NY Employment Type:Full-Time Job Summary:… more
- Nuvance Health (Hyde Park, NY)
- …business office, clinical teams and patient for the denial and appeals process, as necessary. * Maintains communication with System departments (eg, managed ... our patients and each other's success. *Summary:* * The Insurance Reimbursement Specialist is responsible for coordination and support of initiatives relative to the… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management Department in managing retrospective denials. **Qualifications** +… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that patient care services are appropriately recorded and utilized in accordance with ... of care. The UR CR 1 will act as a liaison for discharge appeals and social admissions, preparing regulatory notices for delivery to the patient Minimum… more
- University of Rochester (Rochester, NY)
- …and administrative duties in a fast-paced environment in support of clinical , educational, and academic programs. Responsible for all clinic preparations, including ... preferences. Chooses and recommends among competing demands. - Examines the clinical schedule(s) on a continuous basis to identify opportunities for optimizing… more
- MetLife (Oriskany, NY)
- …with both external and internal resources, such as physicians, attorneys, clinical /vocational consultants as needed to gather data such as medical/occupational ... and thorough manner. Identifies and refers appropriate matters to our appeals , complaint, or litigation support areas. Essential Business Experience and Technical… more
- Garnet Health (Middletown, NY)
- …and rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. ... of DRG and Coding appeal process Required Certification/Registration: * Certified Clinical Documentation Specialist (CCDS) credentialed within 6 months *… more
- Mohawk Valley Health System (Utica, NY)
- …+ Provide guidance and advisory services to physicians, case managers and clinical documentation specialist regarding correct level of care and reimbursement. ... potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals… more
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