- Centene Corporation (New York, NY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Molina Healthcare (NY)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... Nurse (RN). **Required Experience** 1-3 years of hospital or medical clinic experience. **Required License, Certification, Association** Active, unrestricted State… more
- Molina Healthcare (Rochester, NY)
- …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... School of Nursing. **Required Experience** 3+ years hospital acute care/ medical experience. **Required License, Certification, Association** Active, unrestricted State… more
- Molina Healthcare (Buffalo, NY)
- …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... Nurse (RN). **Required Experience** 1-3 years of hospital or medical clinic experience. **Required License, Certification, Association** Active, unrestricted State… more
- Mount Sinai Health System (New York, NY)
- …in IDX using approved methodologies. 8. May perform specialty coding for services and medical office visits and review physician coding and provide updated to ... plus 3 years of relevant experience + Certified coder required + Experience in medical billing or health claims, with experience in EPIC & IDX billing systems in… more
- Mount Sinai Health System (New York, NY)
- …in IDX using approved methodologies. 5. May perform specialty coding for services and medical office visits and review physician coding and provide updates to ... years of relevant experience + 2 years experience in medical billing or health claims, with experience in IDX...practice management or physicians on a scheduled basis to review Accounts Receivable and current billing concerns. 11. May… more
- MUFG (New York, NY)
- …portfolios to identify deterioration or negative management control trends and review compliance with policies, guidelines, and regulations. + Prepare periodic Risk ... age, ancestry, marital status, protected veteran and military status, disability, medical condition, sexual orientation, genetic information, or any other status of… more
- MVP Health Care (Schenectady, NY)
- …for our customers in every interaction **Your key responsibilities:** + Receive and review medical documentation for completeness; conduct outreach to medical ... responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information,… more
- New York State Civil Service (Harriman, NY)
- …Visits each assigned home weekly (minimally) to provide nursing oversight and complete review of items. * Interacts with primary, medical specialists, various ... IES, residential staff. * Annually for everyone in your caseload, completes: review of medical section ISP, medication audit (each home). * Keeps up to date… more
- New York State Civil Service (Washingtonville, NY)
- …each assigned home weekly (minimally) to provide nursing oversight and complete review of items.* Interacts with primary, medical specialists, various clinical ... program, IES, residential staff.* Annually for everyone in your caseload, completes review of medical section ISP, medication audit (each home)* Keeps up to date… more