- Healthfirst (NY)
- **Duties/Responsibilities:** + The Medical Peer Reviewer will assess/ review requests for authorization, and claims payment, based on medical records and ... adjusted based on changing needs of the organization. **Weekday Requirements:** + The Medical reviewer requires 25 hours a week of coverage/5 days per week. +… more
- Evolent (Albany, NY)
- …Stay for the culture. **What You'll Be Doing:** As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can ... needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not...an approval cannot be rendered to the Physician Clinical Reviewer . In States where allowed, will make denial determinations… more
- Insight Global (New York, NY)
- …fully remote Physician Reviewers for a leading health insurance company. The Physician Reviewer will review requests for care before, during, and after treatment ... to confirm they follow medical guidelines and company policies. This includes checking different types of services like hospital stays, rehab care, medical … more
- Guthrie (Cortland, NY)
- …than one year of experience) Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other physician ... plans and related UM requirements preferred. Experience with CPT/ICD coding, medical record or chart auditing, and experience in utilization management processes… more
- Evolent (Albany, NY)
- …Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review rationales and determinations. ... the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are… more
- SUNY Upstate Medical University (Syracuse, NY)
- …defined quality review process. Supports the Attorney General's office in the review and defense of medical malpractice actions brought against the state. ... Job Summary: High level clinical review of patients admitted to University Hospital for...risk identification and referral to clinical departments for ongoing review of quality improvement. Report adverse events to the… more
- TEKsystems (Buffalo, NY)
- Description OVERVIEW: Completes entry-level review of documents from Institutional clients and reports on identified exceptions. PRIMARY RESPONSIBILITIES: Complete ... Custody tracking system to original documents. The data for review is uploaded to the tracking system for reporting...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- Evolent (Albany, NY)
- …improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may ... patients as directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers...to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory… more
- Mizuho Corporate Bank (New York, NY)
- …and enhance Credit Review 's Risk Assessment process. + Draft potential review issues for discussion with relevant Reviewer -in-Charge, Credit Review ... About the Team Credit Review provides the Board and bank management with...generous employee benefits package, including but not limited to Medical , Dental and 401k that begin on day one… more
- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), claims… more