- Arnot Health (Bath, NY)
- …of the Long Term Care staff, attends weekly care conference meetings, and weekly Medicare A review with care team and therapies. + Demonstrates effective time ... of resident care. e. Assists the DON with implementing appropriate review systems for competency-based appraisals of staff. f. Participates in Nursing/Medical… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …timely manner and provides support for the Case Management (CM) and Registered Nurse (RN) reviewers and manages the denial process. + Leads interdisciplinary complex ... the UM/ CM staff. + Participates in clinical peer review recruitment and supervision. + Collaborates with Provider Relations...without restrictions and free of sanctions from Medicaid or Medicare required. + Minimum of five (5) years of… more
- Trinity Health (Albany, NY)
- …for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have ... is strongly preferred). Master's degree preferred. Certification (CPHRM) is preferred. Registered Nurse preferred. Ideally, the candidate will have 3-5 years in risk… more
- The New Jewish Home (Bronx, NY)
- …and procedures. o Monitors quality of care delivered by staff through record review , conferences, supervisory visits and review of aggregated data. o ... the application of continuous improvement principles and best practices among Medicare and Medicaid products, in collaboration with senior leadership and service… more
- MVP Health Care (Tarrytown, NY)
- …**Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse is required. + Case Management Certification preferred (ANCC or CCM). + At ... delivery system, including but not limited to Medicaid and Medicare benefits. + The overall objective is to create...care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate… more
- New York State Civil Service (West Brentwood, NY)
- …hours.*Serve as health advisor to multi-disciplinary team; provide consultation/peer review to other physicians/clinicians; supervise nurse practitioner; ... eligibility for full and unconditional participation in the Medicaid and Medicare programs which must be maintained for continued employment. Failure to… more
- Glengariff Rehabilitation and Healthcare Center (Glen Cove, NY)
- …Demonstrates an understanding of MDS requirements related to varied payers including Medicare , Managed Care and Medicaid + Ensures timely electronic submission of ... on a monthly basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates in, and attends various other… more
- YAI (Queens, NY)
- …of the brain and peripheral nerves . He/she perform s physical examinations, review s medical histories, prescribe s medications and order s various ancillary tests ... Partner with other members of the care team (eg, nurse , medical assistant, social worker ) + Complete all...above) + 2+ years of post-residency experience + Active Medicare and NYS Medicaid registration + Familiarity with the… more
- Catholic Health Services (West Islip, NY)
- …Conditions of Participation. Implements care management programs, including utilization review , intake and discharge planning. Evaluates patient care data to ... is required. Current knowledge of NY Department of Health and Centers of Medicare and Medicaid regulations is required. Knowledge of Joint Commission Standards, and… more