- 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
- 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
- New York State Civil Service (New York, NY)
- NY HELP No Agency Attorney General, Office of the Title Legal Nurse | Review Medical Malpractice Claims for NYS (6402) Occupational Category Legal Salary Grade NS ... Analysts assigned to the Claims Bureau will analyze and review claims containing allegations of medical malpractice; assist attorneys...and be registered to practice as a registered professional nurse or licensed physician in New York state. It… 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
- 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
- Stony Brook University (Stony Brook, NY)
- …effective patient care. + For Nurse Practitioners - Assistance in the annual review Nurse Practitioner protocols. This is a faculty academic position at the ... Critical Care Medicine at the Clinical Instructor level. The Nurse Practitioner/Physician Assistant will join physician faculty of the...event of an unsatisfactory outcome of the disclosure and review process, an offer of employment may be revoked… more
- Sodus Rehab & Nursing Center (Medina, NY)
- …report daily to observe and evaluate each resident's physical and emotional status . Review the nurse 's notes to ensure that they are informative and descriptive ... in completing and performing such tasks . Delegate to each Charge Nurse the administrative authority, responsibility, and accountability necessary to perform his/her… more
- Sodus Rehab & Nursing Center (Herkimer, NY)
- …report daily to observe and evaluate each resident's physical and emotional status . Review the nurse 's notes to ensure that they are informative and descriptive ... and government agencies as required . Delegate to each Charge Nurse the administrative authority, responsibility, and accountability necessary to perform his/her… more
- Lincoln Financial (Albany, NY)
- …proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills **Application ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more