• Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
    Centene Corporation (08/02/25)
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  • Nurse Administrator/Nursing Instructor

    Constructive Partnerships Unlimited (Manhattan, NY)
    …Interdisciplinary Treatment Team to ensure that all team members are aware of all medical conditions and care. 8. Review reports daily to ensure timely, ... in all corporate compliance investigations and reviews. SUPERVISES: Nurse Educators Nurse Case Managers (NCM) Medical Case Manager Counselors (MCMC) more
    Constructive Partnerships Unlimited (08/29/25)
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  • Family Nurse Practitioner (FNP)…

    Community Medical and Dental Care Inc (Monsey, NY)
    …appropriate records relating to all professional services rendered. + Prepare and review reports, claims , and correspondences. Ensure that records and ... Co mmunity Medical & Dental Care, Inc., is a non-profit...Previous experience of at least 2 years as a Nurse Practitioner. + Ability to establish a healthy rapport… more
    Community Medical and Dental Care Inc (08/28/25)
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  • Nurse Practitioner - Psychiatry

    Northern Rivers Family Services (Troy, NY)
    …an NPI. Claims processing functions also require the NPI of nurse practitioners and physicians. + Federal Drug Enforcement Administration (DEA)number - issued by ... Nurse Practitioner - Psychiatry Job Details Job Location...and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate… more
    Northern Rivers Family Services (08/14/25)
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  • Workers Compensation Nurse Case Manager

    Brighton Health Plan Solutions, LLC (Westbury, NY)
    About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review / Medical and Case Management services for Group Health and Workers' Compensation ... and other Casualty clients. The Workers' Compensation Nurse Case Reviewer collaborates with medical care...+ Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability… more
    Brighton Health Plan Solutions, LLC (08/27/25)
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  • Quality Assurance Nurse LTC

    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
    Centene Corporation (08/27/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Albany, NY)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
    Molina Healthcare (08/15/25)
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  • Registered Nurse

    CP Unlimited (Carmel, NY)
    Registered Nurse Type of Position Full time Search Location(s) Carmel, NY, Fishkill, NY, Garrison, NY, Poughkeepsie, NY, Yonkers, NY Apply Now ... (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services to individuals who… more
    CP Unlimited (06/29/25)
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  • Major Case Specialist, Construction

    Travelers Insurance Company (Melville, NY)
    …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
    Travelers Insurance Company (08/14/25)
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  • Licensed Practical Nurse

    BronxCare Health System (Bronx, NY)
    …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Licensed Practical Nurse : Under the direct supervision of a physician...analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
    BronxCare Health System (07/03/25)
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