- CVS Health (Albany, NY)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... in Microsoft Word, Excel, and Outlook - Active and unrestricted Licensed Practical Nurse (LPN) licensure in , Pennsylvania, and/or New Jersey or Compact -… more
- 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 ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Sedgwick (Albany, NY)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
- CVS Health (Albany, NY)
- …for guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on ... coding reviews and resolve intricate issues with sensitivity, including claim reviews for legal, compliance, or rework projects. +...projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the… 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
- Excellus BlueCross BlueShield (Buffalo, NY)
- …and retrospective reviews of claims and appeals and resolves grievances related to medical quality of care, as needed. + Ensures that the medical care ... provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. +...standards and issue. + Ensures that other Behavioral Health medical directors reviewing pediatric cases review those… 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
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role MagnaCare provides Utilization Review / Case Management/ Medical Management/ Claims Review services to its clients. Care Coordinators ... data collection & data entry, and effectively communicating with Nurse Case Reviewers/Managers, employers and claimants in regard to... claims a plus. + Strong skills in medical record review . + Familiarity with … more
- Elevance Health (Latham, NY)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… 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