- 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
- Catholic Health Services (West Islip, NY)
- …(BSN) degree required. Master of Science degree strongly preferred. Licensure: New York Registered Nurse ( RN ) License & Registration. Certification: Care ... limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure… 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 Mount Sinai West FT Days 8a-4p EOW 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. + Current NYS… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …peer-to-peer calls in timely manner and provides support for the Case Management (CM) and Registered Nurse ( RN ) reviewers and manages the denial process. + ... Develops, conducts concurrent and retrospective reviews of claims and appeals and resolves grievances related to medical ...standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those… more
- Arnot Health (Elmira, NY)
- …Auth/Denial Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have ... Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and… more
- Guthrie (Corning, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... appeals for denials as needed * *Monitor and Review REMS clearance for monthly refills of high-risk medications...offices and for DBL office as needed Coverage for RN Nurse Navigator * *Coordinate and facilitate… more
- Stony Brook University (Stony Brook, NY)
- …and other duties as required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license and working history ... following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes...the hospital stay. + Assist with coverage for UR, Appeals and denials + Actively involved in performance improvement… more