- Elevance Health (Latham, NY)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …in the management of medications. POSITION DUTIES 1. Maintain effective communication on medical issues with VP of Nursing, Nurse Administrator, Registered ... Nurse (RN), and Medical Coordinators2. Maintains medical records, including obtaining/filing all necessary reports and maintaining database of individuals… more
- Constructive Partnerships Unlimited (Brooklyn, NY)
- …and SCIP-R. 12. Reports all incidents to the Residence Manager, and reports all medical issues/ injuries to the registered nurse and follows protocols for ... individuals and arranges transportation as necessary. Upon instructions of the Nurse , accompanies individuals on medical appointments and/or visits hospital… more
- Molina Healthcare (Yonkers, NY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more
- Molina Healthcare (NY)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Albany, NY)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- WMCHealth (Poughkeepsie, NY)
- …related to medical staff PI + Screens cases to identify issues for physician review , using criteria established by the medical staff and the NYS DOH. + ... a potential lawsuit, etc.) and alerts the department director, medical staff leadership, and claims manager. +...etc.) and alerts the department director, administration, and the claims manager. Initiates a more thorough review … more
- City of New York (New York, NY)
- …compensability of treatment as it relates to the claimant's work injury and assist with medical case management of claims . Review and process high value and ... Compensation Division are responsible for all medically related issues for medical management of workers' compensation claims . Responsibilities include: Consult… more
- Mount Sinai Health System (New York, NY)
- …for reviewing, summarizing, analyzing, presenting and monitoring safety events, claims management, loss prevention and reduction, patient safety related quality ... + Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign healthcare… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... for delivery of primary care to patients enrolled at the WNY VA Medical Center at the Community Living Centers. The geriatrician will work in collaboration… more