- Trinity Health (Albany, NY)
- …for the overall patient safety and clinical risk management functions related to review and response to reported events. Responds to crisis situations that have ... is strongly preferred). Master's degree preferred. Certification (CPHRM) is preferred. Registered Nurse preferred. Ideally, the candidate will have 3-5 years in risk… more
- The New Jewish Home (Bronx, NY)
- …and procedures. o Monitors quality of care delivered by staff through record review , conferences, supervisory visits and review of aggregated data. o ... the application of continuous improvement principles and best practices among Medicare and Medicaid products, in collaboration with senior leadership and service… more
- Humana (Albany, NY)
- …thresholds and identify appropriate actions when controls indicate process gaps. + Review appeal overturns and provider complaints about coverage policies to make ... skills to make an impact** **Required Qualifications** + Registered Nurse + 2+ years + experience working with CMS...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Glengariff Rehabilitation and Healthcare Center (Glen Cove, NY)
- …Demonstrates an understanding of MDS requirements related to varied payers including Medicare , Managed Care and Medicaid + Ensures timely electronic submission of ... on a monthly basis + Responsible for timely and accurate completion of Utilization Review and Triple Check + Serves on, participates in, and attends various other… more
- New York State Civil Service (Newark, NY)
- …level psychologist, licensed psychologist, licensed physician, licensed psychiatrist, psychiatric nurse practitioner, or licensed clinical social worker (or in the ... research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or as a habilitation… more
- Veterans Affairs, Veterans Health Administration (Castle Point, NY)
- …are required based on DRG/ALOS or type of care provided outside the Medicare Rate. This position includes payment reconciling for Community Care medical claims ... coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability utilization to ensure that clinic schedules are… more
- Calvary Hospital (Bronx, NY)
- …interface with the Finance Office regarding pertinent insurance information, eg Medicare , Medicaid, Blue Cross, and Commercial Insurance. Performs other related ... Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15)...of and experience in Quality Assessment and Improvement, Utilization Review . 9. Ability to develop management systems to track… more
- New York State Civil Service (West Brentwood, NY)
- …hours.*Serve as health advisor to multi-disciplinary team; provide consultation/peer review to other physicians/clinicians; supervise nurse practitioner; ... eligibility for full and unconditional participation in the Medicaid and Medicare programs which must be maintained for continued employment. Failure to… more
- YAI (Queens, NY)
- …of the brain and peripheral nerves . He/she perform s physical examinations, review s medical histories, prescribe s medications and order s various ancillary tests ... Partner with other members of the care team (eg, nurse , medical assistant, social worker ) + Complete all...above) + 2+ years of post-residency experience + Active Medicare and NYS Medicaid registration + Familiarity with the… more
- Catholic Health Services (West Islip, NY)
- …Conditions of Participation. Implements care management programs, including utilization review , intake and discharge planning. Evaluates patient care data to ... is required. Current knowledge of NY Department of Health and Centers of Medicare and Medicaid regulations is required. Knowledge of Joint Commission Standards, and… more