- CDPHP (Albany, 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)
- …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
- 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
- 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...Care, is seeking an experienced Family, Pediatric, or Specialty, Nurse Practitioner. for a full-time or part-time position. We… more
- 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
- 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
- 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
- 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
- FlexStaff (Poughkeepsie, NY)
- …on at least a semiannual basis or as indicated. 3. Coordinate with the Medical Case Manager Counselors (MCMC) to ensure medical , dental, and specialty ... and promptly update as indicated by acute illnesses and/or complex ongoing medical problems. 7. Evaluate the effectiveness of preventive/ongoing health care and make… more