- Mount Sinai Health System (New York, NY)
- …appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials +… more
- Evolent (Albany, NY)
- …Stay for the culture. **What You'll Be Doing:** Job Description 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… more
- Molina Healthcare (Albany, NY)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers. + Represents Molina… more
- Stony Brook University (Stony Brook, NY)
- …+ Perform minor joint procedures. + Work with clinic staff together for insurance appeals and pre-authorizations as necessary. + Coordination with clinic staff ... as assigned by the Division Chief or designee. **Qualifications** **Required Qualifications:** ** NURSE PRACTITIONER:** NYS license and certification as a Nurse … more
- Crouse Hospital (Syracuse, NY)
- …department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission prevention, length ... Manager, Care Coordination 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
- 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 5. Communicates clinical information to the payor, as needed, coordinating… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex ... Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) Plan leadership and… 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 (Corning, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience in nursing, ... 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
- Elevance Health (New York, NY)
- …an impact:** + Receives pre-authorization requests from front-line intake and nurse reviewers. + Conducts initial medical necessity clinical screenings. + Determines ... pre-authorization requests for services. + Conducts review of grievance and appeals requests to provide to Medical Directors. **Minimum Requirements:** + Requires… more