- Centene Corporation (New York, NY)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization...with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive… more
- Fresenius Medical Center (New York, NY)
- …regulatory requirements and programs. Collaborates with the Medical Director and the Clinical Coordinator /Charge Nurse or Nurse Supervisor regarding the ... + Addressing patient concerns, issues, and questions including the review of patient satisfaction surveys. + Developing and communicating...with the Clinical Coordinator /Charge RN or Nurse Supervisor and Medical Director to implement… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Clinical Nurse is a Registered Professional Nurse who provides safe, competent quality care based on nursing theory and research to a ... Care, 5 Minute Sit Down, Purposeful Hourly Rounding, Medication Review , Discharge Wrap Up, and MD/RN Unit Collaboration. 2....and family members who have concerns and escalates to Clinical Nurse Manager/Assistant Nurse Manager/Nursing… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title: Clinical Nurse -MedSurge-Stepdown-10W-Mount Sinai Hospital-FT/Nights** The Clinical Nurse is a Registered Professional ... Care, 5 Minute Sit Down, Purposeful Hourly Rounding, Medication Review , Discharge Wrap Up, and MD/RN Unit Collaboration. +...and family members who have concerns and escalates to Clinical Nurse Manager/Assistant Nurse Manager/Nursing… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior Clinical Nurse is a Registered Professional Nurse with broad knowledge and skills who participates in performance improvement ... a major in nursing required; Masters preferred + Relevant clinical competence in area of nursing practice assigned +...Certification Requirements (if applicable) + Licensed as a registered nurse with current registration in New York State +… more
- YAI (Manhattan, NY)
- …disabilities. PHC has also earned national certification as a Level 3 Patient-Centered Medical Home by the National Committee on Quality Assurance (NCQA). PHC is ... unique in its quality of medical , dental, mental health, rehabilitation and specialty care provided...families. Key/Essential Functions & Responsibilities: + Report to the nurse manager or nurse supervisor, at Premier… more
- Stony Brook University (Stony Brook, NY)
- …effective patient care. + For Nurse Practitioners - Assistance in the annual review Nurse Practitioner protocols. This is a faculty academic position at the ... faculty for the Division of Pediatric Critical Care Medicine at the Clinical Instructor level. The Nurse Practitioner/Physician Assistant will join physician… more
- Stony Brook University (Stony Brook, NY)
- Research Nurse - Cancer Clinical Trials **Position Summary** The **Research Nurse ** for the Cancer Center Clinical Trials Department is responsible for ... Reviews/Data Collection-Determines patient eligibility for protocol participation by way of review of patient's medical records, surgical and pathology reports… more
- Cognizant (Albany, NY)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Molina Healthcare (Rochester, NY)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more