- Trinity Health (Syracuse, NY)
- …in our sisters and brothers. **VISION:** To be world-renowned for passionate patient care and outstanding clinical outcomes. **CORE VALUES:** In the spirit of ... denial coordination with Patient Business Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis… more
- Trinity Health (Syracuse, NY)
- …denial coordination with Patient Business Service (PBS) centers; including analysis of clinical documentation, assist in appeals as needed, root cause analysis ... complete documentation to ensure revenue optimization and integrity. Performs outpatient clinical documentation improvement review (acute only) as needed.… more
- Elderwood (Waverly, NY)
- …handles Third Party appeals , peer to peers as applicable and with clinical oversight provided by the LPN/RN MDS Coordinator. Attends team meetings at the ... Insurance Companies + Knowledge of Medicare and Medicaid Managed Care Policies and Utilization Review . Managed Care Coordinator Skills and Competencies +… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex care management rounds. + Provision of clinical oversight and leadership ... across the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. +...Carve-In program members meets the standards for acceptable medical care + Fosters Clinical Practice Guideline implementation… more
- Molina Healthcare (Albany, NY)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA, FL, MI, MS, ... includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate ...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… more
- Centene Corporation (New York, NY)
- … care management teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants ... Asssts in the development and implementation of physician education with respect to clinical issues and policies. + Identifies utilization review studies and… more
- Stony Brook University (Stony Brook, NY)
- …assess and manage patient care needs, including discharge planning, long-term care , and community-based services. + Manage the clinical and case management ... and experienced Director of Case Management to lead our care management team under the leadership of the Director...collaboration with Social Work Services * Knowledge of Utilization Review and Denial/ Appeals * Knowledge of Data… more
- Evolent (Albany, NY)
- …engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited appeals ,** ensuring compliance with UM ... We Offer:** + A unique opportunity to **impact patient care beyond direct clinical practice.** + A...+ **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or disciplinary… more
- UHS (Johnson City, NY)
- …strong communication skills and a thorough understanding of insurance requirements. You'll review clinical documentation to confirm it meets agency and payer ... reduce delays. At UHS, we believe every connection matters-including the one between clinical care and coverage. Primary Department, Division, or Unit: Patient… more
- Stony Brook University (Stony Brook, NY)
- …a **Case Manager** is a valuable member of our team, who provides clinical services to our patient population. Qualified candidates will demonstrate superior patient ... care and possess outstanding communication skills while adhering to...following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes… more