- Northwell Health (Lake Success, NY)
- …of care provided. Responsible for concurrent inpatient medical record reviews for Medicare , Medicaid and all commercial payers. Generates queries and have follow up ... clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification of… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare + Current nursing experience in Hospital, SNF,… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing… more
- WMCHealth (Warwick, NY)
- …Applicant link Internal Applicant link Job Details: The Coordinator provides professional nurse management of Admissions and Medical Records and is responsible for ... other providers, regulatory agencies, billing agencies, and auditing agencies including Medicare , Medicaid, and third-party billers. + Scans, uploads, and files… more
- Bassett Healthcare (Cooperstown, NY)
- …up emergent situations or expressed patient problems directly to Supervisor or Supervising Nurse for assistance as observed by Supervisor and Supervising Nurse ... of Advanced Beneficiary Notice signatures and form processing to meet Medicare regulations. Ensures all corrections (demographics, insurance eligibility etc. based… more
- New York State Civil Service (Schenectady, NY)
- …primary medical care, working in collaboration with other physician(s) and nurse practitioners or midlevel providers for adults with developmental disabilities and ... Schuylerville. Duties would include but not be limited to review and establish medical histories, perform physical examinations, and...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Molina Healthcare (Rochester, NY)
- **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides ... and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements...focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject… more
- Fresenius Medical Center (Centereach, NY)
- …effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies procedures and training and in compliance ... well-being since their last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and report any unusual… more
- Humana (Albany, NY)
- …medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical ... maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is...any field or equivalent experience + Active unrestricted Registered Nurse (RN) license + 5 years or more of… more
- Bassett Healthcare (Cooperstown, NY)
- …of care (LOC) and hospital protocols to make recommendations for unit placement Review traditional Medicare fee for service (FFS) using the two-midnight rule ... liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate bed is assigned,… more