- Comunilife (Bronx, NY)
- …to assure quality program service delivery and participates in Utilization Review / Quality Improvement process. + Participate in case finding, networking and ... outreach activities to increase clients' enrollment. + Works closely with agency's program directors to ensure assure continuity of care within the organization. Qualifications Education and Experience Requirement(s) + Associate's Degree in human services or… more
- City of New York (New York, NY)
- …the business and technical problems in a manner consistent with FISA standards for quality and completeness. - Review and provide feedback on functional business ... evaluations of the application architecture/technical solutions and development work for quality , completeness, and adherence to FISA and industry standards. -… more
- New York Power Authority (White Plains, NY)
- …sequencing and site outages, coordinate all field & design changes and quality testing/inspections. + Review and contribute to all project documentation ... are completed on time, within budget, and to the highest standards of quality and safety. The multi-discipline projects at our generation and other utility… more
- American Express (New York, NY)
- …this role?** Enterprise Comms & MarTech Experiences (ECMX) enables high quality , innovative marketing through marketing campaign consultation & execution; and ... launch more than 28,000 marketing campaigns worldwide. The Communications Compliance Review (CCR) team within ECMX is responsible for consulting with marketing… more
- Molina Healthcare (Rochester, NY)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Assesses services for… more
- Molina Healthcare (Buffalo, NY)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties *… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. The candidate must have Medicare Appeals and/or… more
- SUNY Upstate Medical University (Syracuse, NY)
- …are appropriately recorded and utilized in accordance with hospital standards of quality , the policies of regulatory agencies, and the negotiated contracts with ... reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the appropriate… more
- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Assesses services for… more
- Centene Corporation (New York, NY)
- …benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. + Performs medical necessity ... criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +… more