• Surgical and Procedural Scheduler

    SUNY Upstate Medical University (Syracuse, NY)
    …all surgical and procedural procedures and assures that all of the appropriate clinical , equipment and insurance coding information is collected for the surgery ... schedule. Scheduler receives requests to schedule procedures from physician offices and schedules the procedure according to established guidelines and policies. Scheduler provides accurate information so that all departments may view daily, and maintains open… more
    SUNY Upstate Medical University (07/24/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Rochester, NY)
    …Looking for a RN with experience with appeals, claims review, and medical coding . **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical … more
    Molina Healthcare (09/06/25)
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  • Medical Director-Payment Integrity

    Humana (Albany, NY)
    …discussions with an external provider. Some roles include an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
    Humana (09/26/25)
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  • Medical Director - Claims Management

    Humana (Albany, NY)
    …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations, clinical reference… more
    Humana (09/17/25)
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  • Medical Director - Southeast Region

    Humana (Albany, NY)
    …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
    Humana (09/10/25)
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  • MDS Supervisor- Clinical Reimbursement…

    Catholic Health Services (Smithtown, NY)
    …- to every resident and patient, every time. Job Details Summary: The Clinical Reimbursement and Quality Management plays a vital role in ensuring accurate ... care and ensuring compliance with regulatory standards. Key Responsibilities: Clinical Reimbursement: + Documentation: Review and analyze resident documentation to… more
    Catholic Health Services (09/24/25)
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  • Clinical Investigator

    MVP Health Care (Rochester, NY)
    …innovative thinking and continuous improvement. To achieve this, we're looking for a ** Clinical Investigator** to join #TeamMVP. This is the opportunity for you if ... professional investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements: A… more
    MVP Health Care (09/20/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Yonkers, NY)
    **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews...pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS… more
    Molina Healthcare (09/26/25)
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  • Director Clinical and DRG Denials

    Kaleida Health (Buffalo, NY)
    **Director Clinical and DRG Denials** **Location:** Larkin Bldg @ Exchange Street Location of Job: US:NY:Buffalo Work Type: Full-Time **Shift:** Shift 1 Job ... Description **Summary:** The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle… more
    Kaleida Health (09/17/25)
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  • Psychiatry - Clinically Trained Post-Doctoral…

    Mount Sinai Health System (New York, NY)
    …is seeking a highly motivated clinically trained post-doctoral fellow to conduct clinical and translational research!** The Icahn School of Medicine at Mount Sinai ... seeking a highly motivated clinically trained post-doctoral fellow to conduct clinical and translational research in psychosis spectrum disorders or mood disorders.… more
    Mount Sinai Health System (08/19/25)
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