- Rochester Regional Health (Rochester, NY)
- …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse IDepartment: Utilization Management Location:...Week: 40 hours (Full-Time)Schedule: Monday - Friday, Days SUMMARY: Review all inpatient medical necessity denials for… more
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case… more
- Molina Healthcare (Yonkers, NY)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of previously ... **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must...for the state they reside This position will support Medical Review for Medicare and Marketplace request… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according ... and/or escalates denial when appropriate. Submits all (initial and/or appeals ) reviews and/or letters within contractual or regulatory timeframes. Collaborates… more
- Stony Brook University (Stony Brook, NY)
- …**Required Qualifications:** * Master's degree. * Possession of license to practice as a registered nurse in New York State * Certification in ACM or CCM ... Work practice and collaboration with Social Work Services * Knowledge of Utilization Review and Denial/ Appeals * Knowledge of Data Analytics **Special Notes**… more
- Guthrie (Binghamton, NY)
- …cases. Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . ... services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within assigned… more
- Independent Health (Buffalo, NY)
- …+ Responsible for all reconsideration clinical appeals to include review of records, consultation with Medical Director, response to facilities ... (CCDS), American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN or LPN… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN /Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred....or a minimum of 3-5 years? experience as a RN in an acute care setting. **Licensing and Certification… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN /Case Manager Inpatient Mount Sinai West FT Days 8a-4p EOW (Holiday Rotation)** The Case Manager (CM) will be responsible for all aspects of ... experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred....or a minimum of 3-5 years? experience as a RN in an acute care setting. + Current NYS… more
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart ... review of identified patients to identify quality, timeliness and...creating a diverse and supportive workplace. Benefits include: + Medical , Rx, Dental & Vision Insurance + Personal and… more
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