- Molina Healthcare (Buffalo, NY)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… 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
- Travelers Insurance Company (New York, 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
- CVS Health (Albany, NY)
- …it all with heart, each and every day. **Position Summary** The Quality Management Nurse (QM Nurse ) supports Aetna Better Health of Texas by ensuring compliance ... clinical expertise with quality improvement leadership, including clinical documentation review , Performance Improvement Projects (PIPs), ANE oversight, and policy… more
- CVS Health (Albany, NY)
- …implementing, and coordinating all case management activities with members to evaluate the medical needs of the member and to help facilitate the member's overall ... - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management… more
- Molina Healthcare (Buffalo, NY)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by… more
- Highmark Health (Albany, NY)
- … review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... rejection and the proper action to complete the retrospective claim review with the goal of proper...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… more
- Humana (Albany, NY)
- …+ Cross train in Physical Health Provider Disputes based on the business need + Review and extract information from claims + Work in partnership with other ... and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- 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
- 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
