- Evolent (Albany, NY)
- …mission. Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse, you will be a key member of the utilization management ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …I Qualifications) + A minimum of 3 years progressive HEDIS experience as per diem clinical reviewer . + Recognized as a HEDIS, QARR, and QRS hybrid subject matter ... Job Description: Summary: In constant pursuit of improving quality outcomes for the Health Plan, this position exists to retrieve and abstract data from medical… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... benefits as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental… more
- Astrix Technology (Albany, NY)
- ** Clinical Data Manager - Remote ** Clinical United States , NY, US Pay Rate Low: 130,000 | Pay Rate High: 150,000 + Added - 30/05/2025 Apply for Job ... **Title:** Clinical Data Manager **Location:** Remote (US-based) **Overview:**...on innovative projects in a collaborative environment, ensuring data quality and compliance with regulatory standards. **Key Responsibilities:** +… more
- Molina Healthcare (Syracuse, NY)
- …HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of ... illness and the site of service. The Lead, HCS ( Clinical ) functions as clinical staff lead in...daily administrative functions including staffing schedules, productivity, and work quality . This position will support our Molina One Care… more
- Mount Sinai Health System (New York, NY)
- …ups in a timely manner and update responses in the appropriate applications. 5. Review clinical status of patient, current treatment plan and past medical ... The Clinical Documentation Query Writer is responsible for the review of the inpatient medical record information for facilitating and distributing compliant… more
- Molina Healthcare (Albany, NY)
- …appropriate departments and committees on others. Identifies and recommends potential clinical measurement and quality improvement activities. + Maximizes use ... **JOB DESCRIPTION** **Job Summary** Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement… more
- Molina Healthcare (Yonkers, NY)
- …effective operations that drive change. + Functions as key lead for clinical chart review /abstraction and team management. This includes qualitative analysis, ... **Job Description** **Job Summary** The Director, Clinical Data Acquisition is responsible for the implementation,...deliverables. This role also works with the Health Plan quality leads to strategically plan for supplemental data source… more
- Evolent (Albany, NY)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... clinical professionals. + A role that values innovation, continuous improvement, and clinical excellence. + **This position is 100% Remote and can be… more
- Centene Corporation (New York, NY)
- …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, ... perspective on workplace flexibility. **Must have a New York State clinical license.** **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs… more