- 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
- Molina Healthcare (Syracuse, NY)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... Office suite/applicable software program(s) proficiency. **Preferred Qualifications** * Certified Clinical Coder (CCC), Certified Medical Audit Specialist … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization ... Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. + Navigates...programs + Provides administrative support to the grievance and appeals process within the + Medical Services department Level… 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
- 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
- Robert Half Accountemps (Rochester, NY)
- Description Ensure full reimbursement is received for clinical services rendered including detail oriented, long-term/home care and hospital care, by effectively and ... phone calls to the payer. Submit corrected claims and appeals . Process account adjustments and refunds as needed according...keep policies and procedures up to date with new clinical programs and payer policy changes. Acquire and maintain… 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
- 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