- Elevance Health (New Hyde Park, NY)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... in hours will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and… more
- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Molina Healthcare (Rochester, NY)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. * Represents Molina… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- Cognizant (Albany, NY)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... + Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Crouse Hospital (Syracuse, NY)
- …department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission prevention, length ... Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +...Dental, Vision, FSA, and 401K. + Company paid life insurance . + Tuition Assistance and Workforce Development Opportunities. +… more
- Elevance Health (New York, NY)
- …will make an impact:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Mount Sinai Health System (New York, NY)
- …current insurance coverage. 5. Collaborates and participates in the appeals process with all members of the interdisciplinary team. 6. Collaborative ... collaboratively with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as needed, coordinating… more
- Guthrie (Binghamton, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience preferred in ... license in the state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient Calls Incoming and… more
- Highland Hospital (Rochester, NY)
- …via telemedicine dependent on clinical availability, personal preference, and insurance guidelines for telemedicine coverage 10-20%Office Practice (Non-Face to Face ... + Complete clinical documentation, forms/paperwork requested by patients, prior authorization appeals , sign home care orders + Coordinate with other providers, home… more
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