- New York State Civil Service (NY)
- …and procedures when needed to ensure the provision of quality care. * Review of lab work, specialty consults, hospital discharges, medical visit summaries and ... the group home, the hospital, the rehabilitation setting and/or community providers.* Review and approval of discharge summaries prior to accepting an individual… more
- New York State Civil Service (Schenectady, NY)
- …Street in Schuylerville. Duties would include but not be limited to review and establish medical histories, perform physical examinations, and manage the medical ... nutrition services to develop individualized therapy plans as necessary.* Review discharge plans from hospitalizations to resume care in...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- WMCHealth (Warwick, NY)
- …other providers, regulatory agencies, billing agencies, and auditing agencies including Medicare , Medicaid, and third-party billers. + Scans, uploads, and files ... off-site records. + Performs other duties as assigned. Admissions + Completes review and assessments of admission referral documents and coordinates the patient… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. - Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of...reports:- - - 2nd insurance level report - - Medicare and Medicaid credit balance report - - Over… more
- Humana (Albany, NY)
- …medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- Intermountain Health (Albany, NY)
- **Job Description:** Provides assistance to the Reimbursement Manager to control or review the following areas for government and third party payers for assigned ... appropriately recorded, reviewed, and reconciled. Reviews or prepares monthly Medicare and Medicaid contractual allowance calculations using technically acceptable… more
- Northwell Health (Garden City, NY)
- …Federal and State regulations. 5.Applies coding rules and regulations to the validation review process. 6.Reviews codes on Medicare /non- Medicare charts for ... clinical expertise to identify and validate DRG code assignment. 2.Full review of CDI suggested code changes 3.Demonstrates comprehensive knowledge of coding… more
- Molina Healthcare (Rochester, NY)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... with a consistent focus on promoting the quality, accuracy, and efficiency of review services. + Serve as a resource and subject matter expert to colleagues… more
- Humana (Albany, NY)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- New York State Civil Service (Orangeburg, NY)
- …looking to hire a Registered Nurse 1, Psychiatric, to serve as a Utilization Review Coordinator (URC). Candidates from outside or within State Service can apply. The ... Proficiency in Microsoft Excel is preferred. URCs at RCPC review electronic and paper clinical medical records for inpatient...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more