- OLV Human Services (Lackawanna, NY)
- …and financial team Documentation Review : * Maintains accurate and timely review of clinical documentation against posted charges; engages provider to ... to 3rd party payers including radiology films and additional clinical documentation * Provides follow up notification to patient...of the approval or denial of the predetermination Billing Review : * Post payments and denials * Utilizes denial… more
- CVS Health (Albany, NY)
- …criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and electronic ... Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong decision-making skills and clinical … more
- University of Rochester (Brighton, NY)
- …+ Ensures accurate and timely data collection, data entry and death record review . + Utilizes clinical judgement and regulatory knowledge to determine which ... internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Medical Records Review Coordinator's (MRRC) primary objective is to fulfill CMS… more
- Premier Medical Group of the Hudson Valley (Poughkeepsie, NY)
- …study protocols. + Ensure all laboratory results are given to appropriate doctors for review of clinical significance, then file results in the patient study ... sending referrals, communication with patients, obtaining prior authorizations, and chart review . + Responsible for organization, cleaning, and re-stocking of exam… more
- BronxCare Health System (Bronx, NY)
- Overview Review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM and CPT-4 codes for billing, ... clarification. - Inputs all codes and other required data into the clinical information system for accurate APC, EAPG assignments. Identifies non-payment conditions… more
- BriteLife Recovery (West Kill, NY)
- …direction of supervisor, establish appropriate therapeutic boundaries, utilization of identified clinical resources to review boundaries, limit setting for ... to and from the facility. The ability to follow the direction of the Clinical Director and BHT Supervisor and safely transport clients in a timely fashion will… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases, Quality ... evidence-based medicine skills are such that the individual provides review oversight for a broad array of clinical... review oversight for a broad array of clinical services. + Reviews and makes recommendations on medical… more
- Stony Brook University (Stony Brook, NY)
- Director of Clinical Research Compliance and Privacy **Position Summary** The Stony Brook Medicine (SBM) Director of Clinical Research Compliance and Privacy ... of the Governing Body. **Duties of a Director of Clinical Research Compliance and Privacy may include the following...DCRCP acts as the primary point of contact for review of agreements that involve any transfers of protected… more
- Northwell Health (Mount Kisco, NY)
- …are represented in the Policy and Procedure Manuals (after appropriate review with clinical and/or administrative personnel); ensures department/division staff ... responsibility in supporting research initiatives; manages daily operations and all non- clinical personnel in the division and all related areas; hires, trains,… more
- Elevance Health (Latham, NY)
- …Requires HS diploma or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more