- Molina Healthcare (Albany, NY)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician RN provides support for clinical member services review assessment processes. Responsible for verifying ... Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in...Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in… more
- Centene Corporation (New York, NY)
- …with our Children member's - ages 0-18.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse. Monitors ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of… more
- Elderwood (Buffalo, NY)
- …Pharmacy Billing Department in Williamsville, NY is seeking an experienced, detail-oriented Accounts Review Specialist to join our team and make a difference in the ... employee reward program: redeem for prizes! Responsibilities Accounts Receivable Review Specialist Responsibilities: + Assisting to facilitate collections of past… 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 ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- American Express (New York, NY)
- …launch more than 28,000 marketing campaigns worldwide. The Communications Compliance Review (CCR) team within ECMX is responsible for consulting with marketing ... databases and Digital Asset Managers, creative development committees, creative review processes, operational controls and projects to update marketing content… more
- Albany Medical Center (Albany, NY)
- …documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and contacts ... Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.* Facilitates removal of delays and documents… 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...years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of… 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 ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- SUNY Upstate Medical University (Syracuse, NY)
- …contracts with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at ... proficiency in clinical conceptual understanding for purposes of level of care review . Strong communication skills, both written and verbal, as well as interpersonal… 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 ... health care experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant… more