- Staffing Solutions Organization (Albany, NY)
- …follow-up questions, and requests for additional documentation. + Building review protocols, establishing written procedures, designing standardized review ... worksheets, and developing training components specific to each new internal review project assigned to the bureau. Reviewing completed worksheets by initial and… more
- City of New York (New York, NY)
- …weekly and monthly reports on Aging Connect call data, special initiatives, and Medicare related metrics. Analyze data to identify ways to improve unit performance. ... issued through Program Instructions are implemented. - Track and review program monthly, mid-year and end of year reports...opportunities to work with older adults. - Track and review volunteer program monthly, mid-year and end of year… more
- WMCHealth (Valhalla, NY)
- …pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered. + Analyze and maintain WMCHealth ... Network Hospitals CDM's to maximize revenue. + Performs periodic review of codes and works with patient billing regarding bundling and unbundling services as… more
- Robert Half Finance & Accounting (Syracuse, NY)
- …to ensure accurate and timely reporting. Responsibilities: * Prepare and review monthly, quarterly, and annual financial statements to ensure accuracy and ... provide insights to department leaders. * Manage regulatory filings, including Medicare cost reports and state-specific financial disclosures, with precision. *… more
- Molina Healthcare (Syracuse, NY)
- …HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- Molina Healthcare (Albany, NY)
- …Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- Humana (Albany, NY)
- …security architecture standards, and guiding engineering teams through the Technology Review Board and Architecture Review Board processes and participating ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Trinity Health (Syracuse, NY)
- …department experience preferred. **Position Purpose:** The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) actively manages the utilization ... review process and patient progression from Admission to Discharge....transition of care from admission to discharge. + Follows Medicare guidelines and industry standards to ensure the proper… more
- Northern Rivers Family Services (Troy, NY)
- …and informal training and education to staff + Prescribe medications, monitor, and review of drug regimen for enrolled individuals + Participate in quality assurance ... community partners, and participate in any quality audit and utilization review + Provide on-site/community based/home visits, medication evaluations, and reviews… more
- Mount Sinai Health System (New York, NY)
- …outcomes. Utilizes internal and community resources, electronic medical record and Centers for Medicare and Medicaid data to educate patients and form a care plan ... timely fashion. 6. May supervise a team of Patient Navigators via chart review , face-to-face case discussions and performance reviews. 7. May work closely with MSH… more