- Elevance Health (New Hyde Park, NY)
- ** Nurse Appeals - Litigation & Legal Support**...entities, and serves as a subject matter expert for appeals , grievances, and quality of care issues. + ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… 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)
- 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
- Catholic Health Services (West Islip, NY)
- …degree required. + Master of Science degree strongly preferred. + Licensure: New York Registered Nurse ( RN ) License & Registration. + Certification: Care ... Care Management: + Works collaboratively with, but not limited to, Medical Staff, Quality /Risk Management, CH Utilization and Central Appeals , Managed Care and… 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 ... social services, therapy, and physician services to ensure appropriate quality of care and reimbursement. 5. MDS Nurse...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 FT Days** The Case Manager (CM) will be responsible for all aspects of case management for an assigned ... on reducing the length of stay (LOS), improved efficiency, quality and resource utilization. Assignment will be by units/clinical...or a minimum of 3-5 years experience as a RN in an acute care setting. Licensing and Certification… more
- Calvary Hospital (Bronx, NY)
- …year Requirements QUALIFICATIONS: 1. Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15) years ... to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts… more