- Evolent (Albany, NY)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** Clinical Reviewer , Physical Therapy As a Clinical Reviewer , ... health outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases,...that an approval cannot be rendered to the Physician Clinical Reviewer . In States where allowed, will… more
- Independent Health (Buffalo, NY)
- …benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical Reviewer will be responsible for the collection and review ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals, document… more
- EGA Associates (Albany, NY)
- …(DOH) is seeking to fill one Registered Nurse as a Hospital Complaint Intake Reviewer to support the complaint intake and review activities for the Centralized ... Urgency** Normal **Offering** Nursing **Profession** RN **Specialty** Complaint Intake Reviewer **Job ID** 17211208 **Shift Details** **Shifts Per Week** 5… more
- City of New York (New York, NY)
- …variety of health-related topics. The office also conducts research and provides clinical expertise in developing health and mental health policies that support best ... in foster care. The New Admissions Focused (NAF) Nurse Reviewer will be responsible for: 1. Scheduling and conducting...5 boroughs 2. Participating in all post medical record review quality monitoring and corrective action processes 3. Conducting… more
- MVP Health Care (Tarrytown, NY)
- …improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a passion for patient-centered ... advocacy, clinical precision and regulatory compliance this is an opportunity...ensure optimal patient care and resource utilization. + Document review outcomes and maintain compliance with regulatory and organizational… more
- Nuvance Health (Poughkeepsie, NY)
- …via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate. ... Must be available during weekday hours. 8a-5p *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement,… 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
- Mount Sinai Health System (New York, NY)
- …Monitoring System. The PM is responsible for all ensuring that all cancer-related clinical research receives appropriate peer- review prior to activation and then ... the IRB, Clinical Research Support Unit (CRSU), and Financial Feasibility Review (FFR) and Community Outreach and Engagement (COE) to align processes, reduce… 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, ... on workplace flexibility. **Must have a New York State clinical license.** **Hours: 8:30am-5pm EST Monday - Friday.** **Position...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… 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, ... and cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in… more