- 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 (Rochester, NY)
- …including hospital acute care/ medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** + ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...scope of a Payment Integrity Clinician. This includes assessing medical documentation, itemized bills, and claims data… more
- Travelers Insurance Company (Melville, NY)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants nurse ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim life cycle… 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
- Community Medical and Dental Care Inc (Monsey, NY)
- …and thorough documentation of all professional services rendered. + Prepare and review reports, claims , and correspondence; ensure that records and documentation ... 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
- 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
- Public Consulting Group (Albany, NY)
- …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost… more
- Mount Sinai Health System (New York, NY)
- …+ Current New York State license as a Registered Professional Nurse or other licensed/certified clinical professional strongly preferred; foreign healthcare ... Conducts Root Cause Analysis investigations, which includes assessing need for focused review by departments, and or clinical chairpersons for peer reviews. 5.… more