- City of New York (New York, NY)
- …health standards for children in foster care. The New Admissions Focused (NAF) Nurse Reviewer will be responsible for: 1. Scheduling and conducting NAF ... 5 boroughs 2. Participating in all post medical record review quality monitoring and corrective action processes 3. Conducting...subject of a child abuse and maltreatment report. STAFF NURSE - 50910 Qualifications 1. A valid New York… more
- EGA Associates (Albany, NY)
- …is seeking to fill one Registered Nurse as a Hospital Complaint Intake Reviewer to support the complaint intake and review activities for the Centralized ... Urgency** Normal **Offering** Nursing **Profession** RN **Specialty** Complaint Intake Reviewer **Job ID** 17211208 **Shift Details** **Shifts Per Week** 5… more
- Independent Health (Buffalo, NY)
- …The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in ... a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals, document research of initial… more
- Nuvance Health (Poughkeepsie, NY)
- …Must be available during weekday hours. 8a-5p *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, ... program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as appropriate.… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care...to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must… more
- Monroe County, NY (Rochester, NY)
- Full Jobs List Full Exams List Registered Nurse (RN) - Utilization Review Unit, Per Diem Location: Rochester, NY Title: Registered Nurse (RN) - Utilization ... Description of Duties This position is in the Utilization Review Unit and functions as an assessment nurse... Review Unit and functions as an assessment nurse . This is a professional nursing position involving responsibility… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- New York State Civil Service (New York, NY)
- NY HELP Yes Agency Mental Health, Office of Title Registered Nurse 1 Psychiatric (NY HELPS), New York State Psychiatric Institute, Utilization review , P26749 ... Zip Code 10032 Duties Description The selected candidate will provide Utilization Review services, including but not limited to conducting daily Utilization … more
- Centene Corporation (New York, NY)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- Molina Healthcare (Rochester, NY)
- …set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... responsible for review of documentation to ensure medical necessity and appropriate...quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review ,… more