- Cognizant (Albany, NY)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to...date. Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… more
- Catholic Health (Buffalo, NY)
- …with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the ... people, carrying out and documenting the appeals process for denied claims denied due to reasons...denied due to reasons including, but not limited to clinical documentation/support for diagnostic related grouping (DRG) assignment, inpatient… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document… more
- Garnet Health (Middletown, NY)
- …and rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. ... of DRG and Coding appeal process Required Certification/Registration: * Certified Clinical Documentation Specialist (CCDS) credentialed * Current license to… more