- New York State Civil Service (Tupper Lake, NY)
- NY HELP Yes Agency People With Developmental Disabilities, Office for Title Nurse Practitioner (Adult Health or Family Health) Occupational Category Health Care, ... psychiatric illness in a residential setting* Works with Psychiatrist to review his consultations of patients with treatment team. Provides psychiatric medication… more
- New York State Civil Service (Commack, NY)
- NY HELP Yes Agency People With Developmental Disabilities, Office for Title Nurse Practitioner (Adult Health or Family Health) Occupational Category Health Care, ... psychiatric illness in a residential setting* Works with Psychiatrist to review his consultations of patients with treatment team. Provides psychiatric medication… more
- New York State Civil Service (Syracuse, NY)
- …HELP Yes Agency People With Developmental Disabilities, Office for Title Registered Nurse 1 Occupational Category Health Care, Human/Social Services Salary Grade 18 ... each assigned home weekly (minimally) to provide nursing oversight and complete review of items. * Interacts with primary, medical specialists, various clinical… more
- New York State Civil Service (NY)
- …HELP Yes Agency People With Developmental Disabilities, Office for Title Registered Nurse 1 Occupational Category Health Care, Human/Social Services Salary Grade 18 ... each assigned home weekly (minimally) to provide nursing oversight and complete review of items. * Interacts with primary, medical specialists, various clinical… more
- Molina Healthcare (Albany, NY)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other… more
- Northwell Health (Lake Success, NY)
- …of care provided. Responsible for concurrent inpatient medical record reviews for Medicare , Medicaid and all commercial payers. Generates queries and have follow up ... clinical documentation in the patient's medical record through a concurrent review process throughout the patient's inpatient stay. 4.Requests clarification of… more
- CenterWell (Albany, NY)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing… more
- Rochester Regional Health (Rochester, NY)
- …Regional Certified Home Health Agency (CHHA) clients under the direction of a Registered Nurse and in compliance with Medicare , Medicaid, and NYS Department of ... and symptoms, and reporting health status changes to the supervising Registered Nurse . + Accurately completes timely documentation in accordance with Federal, State,… more
- Centene Corporation (New York, NY)
- …applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA ... and 2 - 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred.… more
- WMCHealth (Warwick, NY)
- …Applicant link Internal Applicant link Job Details: The Coordinator provides professional nurse management of Admissions and Medical Records and is responsible for ... other providers, regulatory agencies, billing agencies, and auditing agencies including Medicare , Medicaid, and third-party billers. + Scans, uploads, and files… more