- Molina Healthcare (Albany, NY)
- …field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic ... standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). **Preferred Experience** 3-5 years clinical practice with managed care,… more
- Sedgwick (Albany, NY)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- Citigroup (New York, NY)
- …attention to detail. + Demonstrated leadership skills in managing comprehensive review and challenge processes across various business functions. + Willingness to ... our search tools and/or apply for a career opportunity review Accessibility at Citi (https://www.citigroup.com/citi/accessibility/application-accessibility.htm) ._ _View Citi's EEO… more
- City of New York (New York, NY)
- …Community Relations Specialist NM-II to function as the Director of Packet Review and Processing who will: - Be responsible for overseeing the day-to-day ... of completed Homeless Housing Applications (HHA) via HOME and Paper HHA's submissions. Review the ROI forms for the agency, as necessary. - Ensure completed packets… more
- Centene Corporation (New York, NY)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Guthrie (Binghamton, NY)
- …services regarding admissions, case management, discharge planning and utilization review . Responsibilites: Reviews admissions and service requests within assigned ... with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally mandated… more
- WMCHealth (Valhalla, NY)
- …cases when clinical determinations cannot be made by initial clinical review . + Discusses determinations with requesting physicians or ordering providers when ... for standard and expedited appeals. + Participate in peer-to-peer review with payors and/or complete appeals as required to...Physician Advisor or having 3-5 years as a Physician Reviewer /Advisor with a third party leveling and/or appeals agency… more
- The Research Foundation for SUNY (Albany, NY)
- …This is an excellent position for a recent JD or experienced contracts reviewer to begin a career in sponsored programs administration supporting SUNY faculty and ... impactful innovation. The Contracts Specialist will provide high quality contract review , negotiation, with post award support as needed for regulatory compliance.… more
- Molina Healthcare (Yonkers, NY)
- …+ Provides telephone, clerical, and data entry support for the Care Review team. + Provides computer entries of authorization request/provider inquiries, such as ... eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes. + Responds to requests for… more
- City of New York (New York, NY)
- …Staff Analyst NM-I to function as a Deputy Director of Single-Issue Review , who will: Supervise three analytical staff that are responsible for submitting ... over $50 million in claims for federal and state reimbursement. Ensure all participant and invoice data for claims are analyzed, reviewed and compiled accurately. Responsible for ensuring the accurate and timely submissions of Homebase, Anti-Eviction and… more