- Molina Healthcare (Yonkers, NY)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This position will support ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… more
- Rochester Regional Health (Rochester, NY)
- …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse IDepartment: Utilization Management Location:...UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an… more
- CenterWell (Albany, NY)
- …or requested. **Use your skills to make an impact** **Required Experience/Skills:** + Registered Nurse or Physical Therapist. + Current state license as a ... and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather... Registered Nurse or Physical Therapist. + 5… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... hiring a Manager who is responsible for providing day to day management of the RN Care Managers in the department. Pay Range: $95,000 plus based on education and… more
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart review ... of identified patients to identify quality, timeliness and appropriateness of patient care + Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self-pay patients, based on appropriate guidelines + Uses these… more
- Elderwood (Liverpool, NY)
- Salary $38.00 - $49.50 / hourly Overview Are you a Registered Nurse ( RN ) with Medicare experience? Do you consider yourself an expert in assessment and ... for pre and post-pay record reviews, ADR requests and appeals processes. + Manages NYS RUGs III case mix... - MDS Coordinator - Qualifications: + Licensed Professional Nurse ( RN licensure preferred) with current license… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN /Case Manager MSH Case Management FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... or a minimum of 3-5 years? experience as a RN in an acute care setting. **Licensing and Certification...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN /Case Manager Inpatient Mount Sinai West FT Days 8a-4p EOW (Holiday Rotation)** The Case Manager (CM) will be responsible for all aspects of ... or a minimum of 3-5 years? experience as a RN in an acute care setting. + Current NYS...with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the payor, as… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …peer-to-peer calls in timely manner and provides support for the Case Management (CM) and Registered Nurse ( RN ) reviewers and manages the denial process. + ... Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) Plan leadership and… more
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process… more