- 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
- 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
- JPMorgan Chase (New York, NY)
- …be best-in-class. As an Executive Director in the Model Risk Governance & Review (MRGR) group, you will be responsible for conducting model validation and governance ... Control and Line Of Business (LOB) professionals to monitor model performance, review findings, and implement risk mitigating strategies. As part of Risk Management… 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 for ... Demonstrated ability to provide excellent customer service. + Demonstrated ability to review health care delivery against established criteria. + Must be available… more
- University of Rochester (Rochester, NY)
- …+ Support the Tenure committee throughout the process from the point of obtaining reviewer and support letters, track process from review to Board of trustee ... + Supportthe Clinical Promotion committee, the point of obtaining reviewer and support letters, track process from review... reviewer and support letters, track process from review to to provost review and approval.… 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