- Evolent (Albany, NY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse I Department: Utilization Management...UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... Coordination 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
- BronxCare Health System (Bronx, NY)
- …response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal ... Overview The Appeals Manager is responsible to assist in the...electronic database system. -The Appeal Manager should be a nurse who has 3-5 years or more of experience… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
- Molina Healthcare (Buffalo, NY)
- …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal… more
- Molina Healthcare (Albany, NY)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Community Wellness Partners (Oswego, NY)
- …or more than forty (40) hours per week. QUALIFICATIONS: 1. Current NYS Licensed Registered Nurse 2. Knowledge of MDS 3.0, CAA's, Medicare and Medicaid Guidelines ... $75K - $85K/Year GENERAL DESCRIPTION: MDS (Minimum Data Set) nurse collects and assesses information for the health and...Issues NOMNC to residents/responsible party and assists with the appeals process, as needed. 20. Completes QA audits as… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** RN /Case Manager MSH Case Management PT 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 **Certification Requirements:** Current...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the payor, as… more
- Guthrie (Binghamton, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor and Review...offices and for DBL office as needed Coverage for RN Nurse Navigator + Coordinate and facilitate… more