- Molina Healthcare (Rochester, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- New York State Civil Service (New York, NY)
- NY HELP No Agency Attorney General, Office of the Title Legal Nurse | Review Medical Malpractice Claims for NYS (6402) Occupational Category Legal Salary ... to the Claims Bureau will analyze and review claims containing allegations of medical...and be registered to practice as a registered professional nurse or licensed physician in New York state. It… more
- Travelers Insurance Company (Melville, NY)
- …law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through ... of up to $2,000. This position handles First Party Medical Litigation or Arbitration claims from the...facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- Centene Corporation (New York, NY)
- …RN Licensure as well as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Lincoln Financial (Albany, NY)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... will act as a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information to clarify diagnoses,… more
- CVS Health (Albany, NY)
- …in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
- Cognizant (Albany, NY)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... 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… more
- Sedgwick (Albany, NY)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior medical -set-aside experience highly ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Centene Corporation (Queens, NY)
- …terminology such as ICD 10 codes, medical abbreviations, medications. Experience in medical records review , claims processing or utilization and case ... Quality Assurance RN will work in various capacities to review , monitor and train staff in the Long Term...order to ensure that all components of the Member's medical record are completed with quality standards and accuracy… more