- 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
- CVS Health (Albany, NY)
- …Management. - Refer all cases that do not meet applicable criteria or have a potential quality of care issue to a physician reviewer . - Identify and address ... with heart, each and every day. **This is a remote work from home role anywhere in the US...AHH delivers flexible medical management services that support cost-effective quality care for members. - This position consists of… more
- Molina Healthcare (Buffalo, NY)
- …are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** * Performs clinical /medical reviews of ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal...provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician RN provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… 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, ... fresh perspective on workplace flexibility. This is a fully remote position. Applicants must hold an active LPN or...Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. + Performs… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… 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, ... a fresh perspective on workplace flexibility. **This is a remote role but must reside within New York State.**...overall health and appropriate level of care + Reviews quality and continuity of care by reviewing acuity level,… 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, ... benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. + Performs medical necessity… more
- Parexel (Albany, NY)
- …the trial team. + Medical responsibility as co-author for development of a robust Clinical Quality Monitoring Plan (CQMP) in line with the critical data, medical ... Clinical Study Physician. This is a fully remote role! Oncology, Inflammation or CMR preferred** The Study...trial CQMP (and its amendments). + Execution of relevant clinical quality monitoring for Study Physician using… more